Dextro-transposition of the great arteries physical examination: Difference between revisions
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==Physical Examination in Infants with d-TGA== | ==Physical Examination in Infants with d-TGA== | ||
Reversed differential cyanosis (feet less cyanotic than hands) can be a manifestation in patients with d-TGA and '''large patent ductus arteriosus''' that has develop early pulmonary vascular disease, reversing the ductal flow if the patient has survived. At this | '''General physical examination''' | ||
* Symmetric cyanosis | |||
* Delayed mild cyanosis, and the apearence of congestive heart failure accompanies non-restrictive VSD. | |||
* Reversed differential cyanosis (feet less cyanotic than hands) can be a manifestation in patients with d-TGA and '''large patent ductus arteriosus''' that has develop early pulmonary vascular disease, reversing the ductal flow if the patient has survived. At this point in time, the pulmonary arterial blood of high oxygen content enters the aorta and is selectively distribuited to the lower extremities. | |||
'''Cardiovascular examination''' | |||
The first heart sound (S1) is normal in intensity and splitting because the PR interval and ventricular activation is normal. Due to the anterior location of the aorta, the second heart sound (S2) is accentuated and is usually single. | * There is a prominent impulse at the LLSB (the right ventricle which is actually the morphologic left ventricle). | ||
* The first heart sound (S1) is normal in intensity and splitting because the PR interval and ventricular activation is normal. Due to the anterior location of the aorta, the second heart sound (S2) is accentuated and is usually single. | |||
Systolic murmus are absent | * The murmur of a large patent ductus arteriosus in d-TGA, is usually systolic, seldom continuos, due to the almost exclusive flow during systole from the aorta to the pulmonary artery. | ||
* Systolic murmus are absent in neonates unless a subpulmonic stenosis is present. Short midsystolic murmur originate in the anterior aorta when hypervolemia is present. When the pulmonary vascular resistence is low, a midsystolic murmur is originated in the posterior pulmonary artery, but the murmur is dump by the anterior aorta. | |||
A | * A VSD murmur (holosystolic)is absent at birth, until the pulmonary vascular resistence fall. A subsequent increase in pulmonary resistence shortens and later abolishes the murmur. | ||
==References== | ==References== | ||
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*[http://www.kumc.edu/instruction/medicine/pedcard/cardiology/pedcardio/dtgadiagram.gif Diagram at kumc.edu] | *[http://www.kumc.edu/instruction/medicine/pedcard/cardiology/pedcardio/dtgadiagram.gif Diagram at kumc.edu] | ||
*[http://www.med.umich.edu/cvc/mchc/partran.htm Diagram and description at umich.edu] | *[http://www.med.umich.edu/cvc/mchc/partran.htm Diagram and description at umich.edu] | ||
*[http://www.rch.org.au/cardiology/defects.cfm?doc_id=5098 Royal Children's Hospital, Melbourne] | *[http://www.rch.org.au/cardiology/defects.cfm?doc_id=5098 Royal Children's Hospital, Melbourne] | ||
*[http://www.mayoclinic.org/corrected-transposition-great-arteries Mayo Clinic, Arizona - Florida - Minnesota, USA] | *[http://www.mayoclinic.org/corrected-transposition-great-arteries Mayo Clinic, Arizona - Florida - Minnesota, USA] | ||
Revision as of 03:58, 14 August 2011
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Dextro-transposition of the great arteries Microchapters |
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Differentiating dextro-transposition of the great arteries from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Dextro-transposition of the great arteries physical examination On the Web |
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American Roentgen Ray Society Images of Dextro-transposition of the great arteries physical examination |
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FDA on Dextro-transposition of the great arteries physical examination |
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CDC on Dextro-transposition of the great arteries physical examination |
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Dextro-transposition of the great arteries physical examination in the news |
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Blogs on Dextro-transposition of the great arteries physical examination |
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Transposition of the great vessels Microchapters |
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Classification |
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Differentiating Transposition of the great vessels from other Diseases |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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Dextro-transposition of the great arteries physical examination On the Web |
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American Roentgen Ray Society Images of Dextro-transposition of the great arteries physical examination |
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FDA on Dextro-transposition of the great arteries physical examination |
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CDC on Dextro-transposition of the great arteries physical examination |
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Dextro-transposition of the great arteries physical examination in the news |
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Blogs on Dextro-transposition of the great arteries physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]
Overview
Physical Examination in Infants with d-TGA
General physical examination
- Symmetric cyanosis
- Delayed mild cyanosis, and the apearence of congestive heart failure accompanies non-restrictive VSD.
- Reversed differential cyanosis (feet less cyanotic than hands) can be a manifestation in patients with d-TGA and large patent ductus arteriosus that has develop early pulmonary vascular disease, reversing the ductal flow if the patient has survived. At this point in time, the pulmonary arterial blood of high oxygen content enters the aorta and is selectively distribuited to the lower extremities.
Cardiovascular examination
- There is a prominent impulse at the LLSB (the right ventricle which is actually the morphologic left ventricle).
- The first heart sound (S1) is normal in intensity and splitting because the PR interval and ventricular activation is normal. Due to the anterior location of the aorta, the second heart sound (S2) is accentuated and is usually single.
- The murmur of a large patent ductus arteriosus in d-TGA, is usually systolic, seldom continuos, due to the almost exclusive flow during systole from the aorta to the pulmonary artery.
- Systolic murmus are absent in neonates unless a subpulmonic stenosis is present. Short midsystolic murmur originate in the anterior aorta when hypervolemia is present. When the pulmonary vascular resistence is low, a midsystolic murmur is originated in the posterior pulmonary artery, but the murmur is dump by the anterior aorta.
- A VSD murmur (holosystolic)is absent at birth, until the pulmonary vascular resistence fall. A subsequent increase in pulmonary resistence shortens and later abolishes the murmur.
References
Acknowledgements and Initial Contributors to Page
Leida Perez, M.D.
External links
- Diagram at kumc.edu
- Diagram and description at umich.edu
- Royal Children's Hospital, Melbourne
- Mayo Clinic, Arizona - Florida - Minnesota, USA
