Tetralogy of fallot medical treatment: Difference between revisions
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==Overview== | ==Overview== | ||
Although operative repair of tetralogy of Fallot is definitive, medical therapy can be used to manage hypoxic or [[ | Although operative repair of tetralogy of Fallot is definitive, medical therapy can be used to manage [[hypoxic]] or tet spells. [[Tet spells]] cause acute [[hypoxia]] and may be treated with [[beta blockers]], [[morphine]], [[phenylephrine]], and [[oxygen]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
===Emergency Medical Management of Tet Spells=== | ===Emergency Medical Management of Tet Spells=== | ||
Tet spells cause acute [[hypoxia]] and may be treated with: | Tet spells cause acute [[hypoxia]] and may be treated with:<ref>{{cite journal |author=Murakami T |title=Squatting: the hemodynamic change is induced by enhanced aortic wave reflection |journal=Am. J. Hypertens. |volume=15 |issue=11 |pages=986-8 |year=2002 |pmid=12441219}}</ref><ref name="pmid7199417">{{cite journal |vauthors=Abe K, Shimada Y, Takezawa J, Oka N, Yoshiya I |title=Long-term administration of prostaglandin E1: report of two cases with tetralogy of Fallot and esophageal atresia |journal=Crit. Care Med. |volume=10 |issue=3 |pages=155–8 |date=March 1982 |pmid=7199417 |doi=10.1097/00003246-198203000-00003 |url=}}</ref><ref name="pmid24936003">{{cite journal |vauthors=Tsze DS, Vitberg YM, Berezow J, Starc TJ, Dayan PS |title=Treatment of tetralogy of Fallot hypoxic spell with intranasal fentanyl |journal=Pediatrics |volume=134 |issue=1 |pages=e266–9 |date=July 2014 |pmid=24936003 |doi=10.1542/peds.2013-3183 |url=}}</ref> | ||
* [[Beta-blockers]] such as [[propranolol]] or esmolol. The beta-blockers causes relaxation of the [[right ventricular outflow tract]] and increases [[blood flow]] into the pulmonary vessels. | * [[Beta-blockers]] such as [[propranolol]] or esmolol. The beta-blockers causes relaxation of the [[right ventricular outflow tract]] and increases [[blood flow]] into the pulmonary vessels. | ||
* [[Morphine]] to reduce ventilatory drive | * [[Morphine]] to reduce ventilatory drive | ||
* [[Phenylephrine]] to increase systemic afterload that in turn increases the flow across [[right ventricle]] and the [[pulmonary artery]] and decreases right to left shunting. | * [[Phenylephrine]] to increase systemic afterload that in turn increases the flow across [[right ventricle]] and the [[pulmonary artery]] and decreases right to left shunting. | ||
* Procedures such as the knee-chest position which increases aortic wave reflection, increasing pressure on the left side of the [[heart]], decreasing the [[right-to-left shunt]] thus decreasing the amount of deoxygenated blood entering the systemic circulation. | * Procedures such as the knee-chest position which increases aortic wave reflection, increasing pressure on the left side of the [[heart]], decreasing the [[right-to-left shunt]] thus decreasing the amount of deoxygenated blood entering the systemic circulation. | ||
* [[Oxygen]] is ineffective in treating hypoxic spells as the underlying problem is lack of blood flow through the pulmonary circuit and not alveolar oxygenation. | * [[Oxygen]] is ineffective in treating hypoxic spells as the underlying problem is lack of blood flow through the pulmonary circuit and not alveolar oxygenation. | ||
* In case all these measures fail, an emergency [[Blalock-Taussig shunt]] might be needed. | * In case all these measures fail, an emergency [[Blalock-Taussig shunt]] might be needed. | ||
===Prostaglandins=== | ===Prostaglandins=== | ||
[[Prostaglandin]]s can be administered while awaiting [[surgery]] to maintain patency of the [[ductus arteriosus]]. | |||
* [[Prostaglandin]]s can be administered while awaiting [[surgery]] to maintain patency of the [[ductus arteriosus]]. | |||
===Antibiotic Prophylaxis=== | ===Antibiotic Prophylaxis=== | ||
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==References== | ==References== | ||
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[[Category:Disease]] | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Congenital heart disease]] | [[Category:Congenital heart disease]] | ||
[[Category:Pediatrics]] | |||
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Latest revision as of 18:38, 14 April 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]
Overview
Although operative repair of tetralogy of Fallot is definitive, medical therapy can be used to manage hypoxic or tet spells. Tet spells cause acute hypoxia and may be treated with beta blockers, morphine, phenylephrine, and oxygen.
Medical Therapy
Emergency Medical Management of Tet Spells
Tet spells cause acute hypoxia and may be treated with:[1][2][3]
- Beta-blockers such as propranolol or esmolol. The beta-blockers causes relaxation of the right ventricular outflow tract and increases blood flow into the pulmonary vessels.
- Morphine to reduce ventilatory drive
- Phenylephrine to increase systemic afterload that in turn increases the flow across right ventricle and the pulmonary artery and decreases right to left shunting.
- Procedures such as the knee-chest position which increases aortic wave reflection, increasing pressure on the left side of the heart, decreasing the right-to-left shunt thus decreasing the amount of deoxygenated blood entering the systemic circulation.
- Oxygen is ineffective in treating hypoxic spells as the underlying problem is lack of blood flow through the pulmonary circuit and not alveolar oxygenation.
- In case all these measures fail, an emergency Blalock-Taussig shunt might be needed.
Prostaglandins
- Prostaglandins can be administered while awaiting surgery to maintain patency of the ductus arteriosus.
Antibiotic Prophylaxis
- Antibiotic prophylaxis is suggested to prevent infective endocarditis, particularly in the repaired tetralogy of Fallot patient with a patch.
References
- ↑ Murakami T (2002). "Squatting: the hemodynamic change is induced by enhanced aortic wave reflection". Am. J. Hypertens. 15 (11): 986–8. PMID 12441219.
- ↑ Abe K, Shimada Y, Takezawa J, Oka N, Yoshiya I (March 1982). "Long-term administration of prostaglandin E1: report of two cases with tetralogy of Fallot and esophageal atresia". Crit. Care Med. 10 (3): 155–8. doi:10.1097/00003246-198203000-00003. PMID 7199417.
- ↑ Tsze DS, Vitberg YM, Berezow J, Starc TJ, Dayan PS (July 2014). "Treatment of tetralogy of Fallot hypoxic spell with intranasal fentanyl". Pediatrics. 134 (1): e266–9. doi:10.1542/peds.2013-3183. PMID 24936003.