Hypoxic Spell

Pediatric Cardiology Division

Structures of the heart
• Congenital heart disease
– Acyanosis congenital heart disease
– Cyanosis congenital heart disease : ToF etc

• Hypoxic Spell --> Cyanotic Spell, hypercyanotic spell,

“tet” spell

• Requires immediate recognition and appropriate

treatment cause it can lead to serious complications
of the CNS
 Tetralogy Fallot

Syndrome consist of 4
items:
 VSD
 Pulmonary stenosis
 Aortic over-riding
 RVH
• Hypoxic spells occur in infants, with a peak incidence between 2
and 4 months of age

• Hypoxic spells are characterized by:

- paroxysm of hyperpnea
- irritability and prolonged crying
- increasing cyanosis
- decreasing intensity of the heart murmur
- usually occur in the morning after crying, feeding, or
defecation.
- severe spell may lead to limpness, convulsion,
cerebrovascular accident, or even death.
• Physicians may use one or more
of the following to treat the
spell :

- Knee chest position

- Morphine sulfate, 0.2
mg/kgbw sc or im
- Oxygen
- Acidosis should be treated
with sodium bicarbonate
(NaHCO3), 1 mEq/kg iv. can be
repeated in 10 to 15 minutes
Outcomes : with the preceding treatment --> becomes less cyanotic, and
the heart murmur becomes louder, which indicates an increased amount
of blood flowing through the stenotic RVOT

•If the hypoxic spells do not fully respond to these measures, the
following medications can be tried:

1. Vasoconstrictors such as phenylephrine (NeoSynephrine)

0.02 mg/kg iv, by raising systemic arterial pressure
2. Ketamine, 1 to 3 mg/kg (average of 2 mg/kg) iv over 60 sec,
it increases the systemic vascular resistance and sedates
the infant
3. Propranolol, 0.01 to 0.25 mg/kg (average 0.05 mg/kg) by slow
iv push, reduces the heart rate and may reverse the spell
THANK YOU

GAMBAR OPERASI PERICARDIAL WINDOW

8