The congenital heart disease in which radiographic findings depict boot-shaped heart is called?

DSSSB - 28 August 2019 (Shift-1)

Child Health Nursing (Pediatrics)

Easy

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease that classically presents with a 'boot-shaped heart' on chest X-ray.
This distinctive shape, also called 'coeur en sabot', is caused by two of the four defects: right ventricular hypertrophy (RVH) and an underdeveloped (hypoplastic) main pulmonary artery.
The RVH causes the apex of the heart to be lifted upwards, forming the 'toe' of the boot.
The small or concave main pulmonary artery segment creates the narrow 'ankle' of the boot shape.

Option A: Patent Ductus Arteriosus (PDA) is an acyanotic defect. Radiographically, it typically shows cardiomegaly (enlarged heart) and increased pulmonary vascular markings due to a left-to-right shunt, not a boot shape.
Option B: Atrial Septal Defect (ASD) also causes a left-to-right shunt, leading to enlargement of the right atrium and right ventricle, and increased blood flow to the lungs. However, it does not create the specific upturned apex and concave pulmonary artery that define the boot shape.
Option C: Coarctation of the Aorta is a narrowing of the aorta. Its classic X-ray signs are the 'figure-3' sign along the aortic knob and rib notching (due to collateral circulation through intercostal arteries). These findings are completely different from the boot-shaped heart.

Clinical Relevance

Nursing practice connection: Knowing Radiographic findings in congenital heart disease helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Recognizing the 'boot-shaped heart' on a chest X-ray is a critical diagnostic clue for nurses and healthcare providers, prompting immediate further investigation with echocardiography to confirm Tetralogy of Fallot.
Infants with TOF may exhibit 'tet spells'—episodes of profound cyanosis and hypoxia, often triggered by crying or feeding. A key nursing intervention is to place the infant in a knee-chest position, which increases systemic vascular resistance and promotes blood flow to the lungs.
What if the X-ray showed an 'egg-on-a-string' appearance instead? This would suggest a different cyanotic heart defect, Transposition of the Great Arteries (TGA), where the aorta and pulmonary artery are switched. The clinical management would be different, often requiring an immediate procedure to create a shunt for blood mixing.

How to Approach the Question

First, analyze the question stem to identify the key phrase: 'boot-shaped heart'. This is a classic radiological sign.
Next, examine the provided image. Visually confirm that the heart silhouette on the X-ray matches the description of a 'boot shape' (upturned apex, concave pulmonary artery segment).
Recall or deduce the congenital heart disease specifically associated with this pathognomonic finding.
Evaluate the given options. Patent Ductus Arteriosus, Atrial Septal Defect, and Coarctation of Aorta have different radiological presentations.
Select 'Tetralogy of Fallot' as it is the only condition among the options that is defined by the 'boot-shaped heart' sign.

Concept Tested & Keywords

Concept Tested: Radiographic findings in congenital heart disease
Stem keywords: congenital heart disease, radiographic findings, boot-shaped heart
Lead-in keywords: is called
Clinical cues: The visual cue of a 'boot-shaped heart' on the X-ray is the key to solving this question.

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