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TETRALOGY OF FALLOT
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INTRODUCTION
Tetralogy of Fallot is cyanotic type of
congenital heart disease, that consists of 4
anomalies in cardiac structure.
Incidence of this type of CHD is 10-15% of all
congenital heart disease, and is 2/3 of
cyanotic congenital heart disease, with
different incidence on each country.
CASE
HISTORY OF DISEASE
MAZ, a boy, 3 years and 2 months old, with
body weight 10 kg and body height 90 cm,
was admitted to Haji Adam Malik Central
General Hospital Medan on 02nd August 2016
at 11.00 a.m. with a main complaint of
dypsnoe and sianosis. The main complaint
was experienced since the last 3 days and
became severe.
OTHER HISTORIES
History of Previous Disease :
Tetralogy of Fallot.
History of Medication :
Paracetamol syrup
Not clear
:3
Standing: 12 months
Walking : 14 months
Talking
: 12 months
PHYSICAL EXAMINATION
Presence Status :
Sensorium
Mentis
: Compos
Nutrition Status :
Body weight
Body height
BP
: 90/50 mmHg
Weight-for-age
HR
: 112 bpm
RR
: 26 pm
Stature-for-age
z < 0)
T : 36,8 C
: 10 kg
: 90cm
: 71% (z < -3)
: 93 % ( -2 <
PHYSICAL EXAMINATION
(CONTD)
Localized Status (contd) :
Head :
Shape : Normal.
Face
Eye
: Edema (-).
E/N/M : WNL/WNL/WNL.
PHYSICAL EXAMINATION
(CONTD)
Localized Status (contd) :
Neck
: Lymph node enlargement (-).
Thorax
:
Inspection
: SF, retraction (+).
Palpation
: Normal tactile fremitus, right = left.
Percussion
: Normal resonance.
Auscultation
: Vesicular, RR : 26 pm, regular, rh (-/-),
wh (-/-).
Heart
PHYSICAL EXAMINATION
(CONTD)
Localized Status (contd) :
Abdomen : Soepel, peristaltic (+) normal, liver,
spleen, and
mass are not palpable.
Extremities : Pulse : 112 bpm, regular, adequate
p/v, warm
skin, CRT < 3 seconds, edema (-),
clubbing
fingers (+).
Anogenital : Male, penis (+), testis (+), within
normal limit.
LABORATORY
EXAMINATION
Complete Blood Count and RFT (2nd August
2016 / 16.32)
Test Type
Hemoglobin
Erythrocyte
Leucocyte
Result
15,5
8,14
8,340
Unit
g/dL
million/L
/L
Thrombocyte
467,000
/L
53
65
19
29,1
%
fL
pg
g/dL
Reference Value
13 18
4.50 6.50
4,500 13,500
150,000
450,000
39 54
81 99
27.0 31.0
31.0 37.0
0.40
1,80
54,60
34,40
8,80
%
%
%
%
%
0.00 1.00
1.00 3.00
50.00 70.00
20 50
2.00 8.00
Hematocrite
MCV
MCH
MCHC
Differential Count
Basophil
Eosinofil
Neutrophil
Lymphocyte
Monocyte
Test Type
Blood Urea Nitrogen
(BUN)
Ureum
Creatinine
GFR
Result
Unit
Reference Value
mg/dL
9 21
15
0.34
mg/dL
mg/dL
mL/min/1.73
m2
19 44
0.7 1.3
55.96
96.5 136.9
DIAGNOSIS
Differential Diagnosis
: 1. Tetralogy of Fallot
2. TGA
Working Diagnosis
: Tetralogy of Fallot
THERAPY
Activity : Bed rest
Therapy : O2 1 liter/ menit via nasal canule
PLANNING ASSESMENT
AGDA
Electrocardiography
Echocardiography
Kateterization
FOLLOW UP
Post Kateterisasi :
IVFD D5% Nacl 0.45% 4cc/ hours
Parasetamol 3x120 mg
Propanolol 2x6 mg
Laxadyn syr 3 x cth II (k/p)
R/ Refer for total correction
A
P
DISCUSSION
ChestX-Ray
Electrocardiogram
Management Therapy
1.Meletakan pasien dalam posisi menungging (knee
chest position),
sambil mengamati bahwa pakaian yang melekat
tidak sempit
2.Pemberian O2
3.Koreksi asidosis metabolik dengan NaHCO3
4.Pemberian propanolol 0,1 mg/kgBB intra vena
5.Pemberian morfin subkutan atau IV 0,1 mg/kgBB
SUMMARY
MAZ, 3 year 2 months old boy, that weighted 10 kg
and lengthed 90 cm, was admitted to Pediatric
Department Unit in H. Adam Malik General Hospital
Medan on August 2nd 2016 with main complaint was
dyspnoe and cyanosis since 3 days before hospital
admission. He is diagnosed with Tetralogy of Fallot.
Patient is treated with propranolol 2x6 mg and
Laxadyn syr 3 x cth II (k/p).
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