In which disease condition a boot shaped heart is seen in chest X-ray?

AIIMS Manglagiri NO - 2019

Child Health Nursing (Pediatrics)

Easy

Appeared in: AIIMS Manglagiri NO - 2019

Explanation

Tetralogy of Fallot (TOF) is a congenital heart defect characterized by four specific anatomical abnormalities.
On a chest X-ray, TOF classically presents as a "boot-shaped heart," also known as coeur en sabot.
This distinctive shape is caused by right ventricular hypertrophy (thickening of the right ventricle wall), which lifts the apex of the heart upwards, forming the 'toe' of the boot.
A concave or underdeveloped main pulmonary artery segment contributes to the narrow 'ankle' of the boot appearance.

Option A: Patent Ductus Arteriosus (PDA) does not cause a boot-shaped heart. Instead, it leads to increased blood flow to the lungs (pulmonary plethora), which appears as increased vascular markings on an X-ray, and may cause cardiomegaly (enlarged heart).
Option B: Transposition of the Great Arteries (TGA) has a different characteristic X-ray finding. It is known for the "egg-on-a-string" sign, where the heart has an ovoid shape and the superior mediastinum is narrow.
Option C: Tricuspid Atresia does not typically show a boot-shaped heart. The X-ray usually reveals decreased pulmonary blood flow (oligemic lung fields) because blood has difficulty reaching the lungs due to the absent tricuspid valve and an underdeveloped right ventricle.

Clinical Relevance

Nursing practice connection: Use the key finding related to Radiographic findings in congenital heart diseases to guide bedside assessment, documentation, and the next nursing action.
Recognizing classic radiographic signs like the 'boot-shaped heart' is a critical skill for nurses, especially in pediatric and neonatal care, as it can help in the rapid identification of potentially life-threatening congenital heart defects.
Early detection of TOF allows for timely medical management (e.g., prostaglandin infusion to maintain ductal patency) and surgical planning, which significantly improves patient outcomes.
Nurses play a key role in monitoring infants for signs of cyanosis, especially during feeding or crying ('tet spells'), which are common in TOF and require immediate intervention.

How to Approach the Question

First, identify the key phrase in the question: "boot shaped heart". This is a classic, specific finding.
Access your knowledge of cardiology and pediatrics to recall which congenital heart disease is associated with this specific X-ray sign.
Systematically evaluate each option. Think about the characteristic findings for each condition.
Option A (PDA) is associated with increased lung markings.
Option B (TGA) is known for the 'egg-on-a-string' sign.
Option C (Tricuspid Atresia) is associated with decreased lung markings.

Concept Tested & Keywords

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

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 588-590