Which of the following condition that reveals boot shaped heart in Radiography?

Appeared in: NVS Staff Nurse - 2022

Explanation

Tetralogy of Fallot (TOF) is the classic cause of a 'boot-shaped heart' or 'Coeur en sabot' on a chest radiograph.
This appearance is due to right ventricular hypertrophy, which causes the cardiac apex to be upturned.
A concave main pulmonary artery segment, resulting from pulmonary stenosis and reduced blood flow, forms the 'instep' of the boot.
TOF is the most common cyanotic congenital heart disease.

Option A: Coarctation of the Aorta does not cause a boot-shaped heart. Its classic radiographic signs are different.
Option C: Isolated Pulmonary Stenosis typically leads to post-stenotic dilation of the pulmonary artery, which appears as a bulge, not the concavity seen in a boot-shaped heart.
Option D: Aortic Stenosis primarily affects the left side of the heart, leading to left ventricular hypertrophy and a prominent ascending aorta, not a boot shape.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Radiographic findings in congenital heart disease as background academic context rather than a clinical decision trigger.
Recognizing the 'boot-shaped heart' is a critical skill for nurses and physicians in identifying potential cases of Tetralogy of Fallot, especially in infants presenting with cyanosis ('blue baby syndrome').
Early identification through radiography prompts further investigation with echocardiography, leading to timely surgical intervention which is crucial for survival and quality of life.
What if? If a newborn presents with cyanosis but the chest X-ray shows an 'egg-on-a-string' sign instead of a boot shape, the most likely diagnosis would be Transposition of the Great Arteries (TGA), requiring a different immediate management approach to ensure mixing of oxygenated and deoxygenated blood.

How to Approach the Question

First, identify the key phrase in the question: 'boot shaped heart'.
This is a classic, high-yield radiographic sign in cardiology. Access your memory for its direct association.
Recall that 'boot-shaped heart' or 'Coeur en sabot' is pathognomonic for Tetralogy of Fallot.
Evaluate the options to find Tetralogy of Fallot.
Mentally differentiate this sign from the radiographic findings of the other listed conditions (e.g., 'figure of 3' for coarctation, post-stenotic dilation for pulmonary stenosis) to confirm your answer.

Concept Tested & Keywords

QMhhbIwLRKm13kpvc1nBwm

E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 2 (215-514) p. 1-3

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 544-546

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