Transposition Of The Great Arteries- A Congenital Heart Defect.

Transposition of the great arteries is a serious but rare congenital heart defect present in which the two main arteries leaving the heart are reversed (transposed). Transposition of the great vessels is a cyanotic heart defect. This means there is decreased oxygen in the blood that is pumped from the heart to the rest of the body. It is usually detected either prenatally or within the first hours to weeks of life.

Pathophysiology: In normal hearts, blood that returns from the body goes through the right side of the heart and pulmonary artery to the lungs to get oxygen. The blood then comes back to the left side of the heart and travels out the aorta to the body.

In transposition of the great vessels, the blood goes to the lungs, picks up oxygen, returns to the heart, and then flows right back to the lungs without ever going to the body. Blood from the body returns to the heart and goes back to the body without ever picking up oxygen in the lungs.

Clinical Features: Symptoms of Transposition of the great arteries  include:

Tetralogy Of Fallot- A Congenital Heart Defect.

Tetralogy of Fallot (TOF) is a congenital heart disorder that is present at birth. The condition is caused by a combination of four heart defects hence the name tetralogy.

1. Ventricular septal defect (hole between the right and left ventricles)
2. Narrowing of the pulmonary outflow tract (the valve and artery that connect the heart with the lungs)
3. Overriding aorta (the artery that carries oxygen-rich blood to the body) that is shifted over the right ventricle and ventricular septal defect, instead of coming out only from the left ventricle
4. Thickened wall of the right ventricle (right ventricular hypertrophy)

These defects, cause oxygen-poor blood to flow out of the heart and to the rest of the body. Infants and children with tetralogy of Fallot usually have blue-tinged skin because their blood doesn't carry enough oxygen. It is classified as a cyanotic heart disease and is the most common form of cyanotic congenital heart disease.

Causes: The cause(s) of most congenital heart diseases (CHDs) are unknown, although genetic studies suggest a multifactorial etiology.

Prenatal factors associated with a higher incidence of tetralogy of Fallot (TOF) include:

• maternal rubella (or other viral illnesses) during pregnancy, 
• poor prenatal nutrition, 
• maternal alcohol use, 
• maternal age older than 40 years, 
• maternal diabetes. 
• Children with Down syndrome also have a higher incidence of tetralogy of Fallot, as do infants with fetal hydantoin syndrome or fetal carbamazepine syndrome.

Clinical Features: 

Tetralogy of Fallot symptoms vary, depending on the extent of obstruction of blood flow out of the right ventricle and into the lungs. Signs and symptoms may include:

A Young Man Who Is Otherwise Healthy Presents With A Sandpaperlike Rash ...

A 20-year-old man presents to your office complaining of a sandpaperlike rash that affects his upper outer arms. He is otherwise healthy and has no other symptoms. The most likely diagnosis is
A) Scarlet fever
B) Infectious mononucleosis
C) Keratosis pilaris
D) Seborrheic dermatitis
E) Psoriasis

The rash is shown in picture below:

The answer is C. (Keratosis pilaris)

Keratosis pilaris is defined as hyperkeratotic follicular papules on the extensor surface of the upper arms or upper anterior thighs and occasionally on the malar area of the face.

Asbestosis And The Pneumoconioses (With X rays For Better Understanding)

The pneumoconioses are occupational lung diseases caused by inhalation of a variety of industrial dusts. Strictly speaking, asbestosis is a subtype of the pneumoconioses but, because of its relative prevalence, it tends to be considered separately. Likewise, coal worker’s pneumoconiosis (CWP) merits its own discussion.
Pneumoconioses may take two forms;
• Benign forms tend to be asymptomatic. They can be recognized by the CXR appearances that they produce: small round opacities caused by perivascular collections of dust.

Small round opacities are shown by arrow in bening forms of Pneumoconioses


• Fibrotic forms produce, as the name suggests, pulmonary fibrosis associated with a restrictive lung defect. They may cause symptoms and sometimes progress to respiratory failure.

                                       Radiograph showing Progressive Massive Fibrosis

Asbestosis: The interstitial fibrosis produced by asbestos exposure is dose related, with length and

X-Rays In Cardiovascular Diseases.

Below are given a few chest x rays that would help understand reading a chest X ray particularly in regard to cardiovascular disease .

A 36 Year Old Woman presents With Tingling And Pain In The Right Thumb And Wrist.

A 36-year-old data entry clerk presents to your office complaining of tingling and pain in the right thumb and wrist, worse by the end of the day. Occasionally, she is awakened at night from the pain. Phalen's, Tinel's, and median nerve compression tests are positive. The hand and wrist appear otherwise normal, with full range of motion, good perfusion, and no focal signs of inflammation or trauma. 

Q 1. What is the most likely diagnosis? 

Answer: Carpal tunnel syndrome. 

Q 2. Which of the following treatment modalities would be your first choice in alleviating pain in this patient?
A. Steroid and lidocaine injection into the carpal tunnel
B. Wrist splinting in neutral or slight extension
C. Trigger point injection
D. Surgical release of the transverse carpal ligament
E. Iontophoresis therapy

 Answer :