Cyanotic spell is a feature of?

SCTIMST Staff Nurse - 2015 (Set-A)

Child Health Nursing (Pediatrics)

Easy

Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)

Explanation

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease after infancy.
Cyanotic spells ('Tet spells') are a hallmark of TOF, characterized by sudden, profound cyanosis and hypoxia.
These spells are caused by an acute increase in right-to-left shunting of deoxygenated blood across the ventricular septal defect (VSD).
Triggers include crying, feeding, or agitation, which can cause a spasm of the right ventricular outflow tract (infundibular spasm) or a drop in systemic vascular resistance.
The underlying anatomy of TOF, particularly the VSD and pulmonary stenosis (as shown in the image), allows this shunting to occur.

Option B: A Ventricular Septal Defect (VSD) is typically an acyanotic defect. It causes a left-to-right shunt, leading to pulmonary overcirculation, not cyanotic spells.
Option C: A Patent Ductus Arteriosus (PDA) is an acyanotic defect causing a left-to-right shunt. It does not cause cyanotic spells.
Option D: An Atrial Septal Defect (ASD) is an acyanotic defect with a left-to-right shunt. It is generally well-tolerated and does not cause cyanotic spells.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology of congenital heart defects, specifically Tetralogy of Fallot as background academic context rather than a clinical decision trigger.
Recognizing a Tet spell is a critical nursing skill, as it is a medical emergency requiring immediate intervention to prevent severe neurological complications or death.
The primary nursing action is to place the infant in the knee-chest position to increase systemic vascular resistance and improve pulmonary blood flow.
Nurses play a key role in educating parents on how to recognize triggers for spells (like dehydration, fever, and prolonged crying) and how to respond at home while seeking emergency care.

How to Approach the Question

First, identify the key clinical sign in the question: 'cyanotic spell'.
Recall the classification of congenital heart defects into cyanotic and acyanotic categories.
Associate the specific term 'cyanotic spell' or 'Tet spell' with its classic underlying condition, which is Tetralogy of Fallot (TOF).
Analyze the other options (VSD, PDA, ASD) and recognize them as typically acyanotic defects (left-to-right shunts) that do not cause such spells.
Use the provided image, which shows the four anatomical defects of TOF, to confirm that this condition provides the necessary pathophysiology (VSD + right ventricular outflow obstruction) for a cyanotic spell to occur.

Concept Tested & Keywords

Concept Tested: Pathophysiology of congenital heart defects, specifically Tetralogy of Fallot.
Stem keywords: Cyanotic spell
Lead-in keywords: is a feature of
Clinical cues: The term 'cyanotic spell' is a pathognomonic sign strongly associated with Tetralogy of Fallot.

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) pp. 436-438, 444-446

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 541-543