TETRALOGY OF FALLOT

Characteristics:
Cyanotic heart disease
Right to left shunt
Combination of four cardiac defects
Ventricular Septal Defect (Increased pulmonary blood flow)
Pulmonary Stenosis (Obstruction to blood leaving the heart)
Right ventricular hypertrophy
Dextroposition of he Aorta

Causes:
Fetal Alcohol Syndrome
Thalidomide use during pregnancy

Risk Factors:
Children with congenital heart disease (10%)
Both sexes

Clinical Manifestations:
Cyanosis (hallmark of TOF)
Cyanotic or blue or tet Spells
Characterized by:
Dyspnea
Sighing respiration
Bradycardia
Fainting (syncope)
Seizures
Loss of consciousness following exercise
Crying
Infection
Fever
Clubbing, severe dyspnea, growth retardation and eating difficulties
Assumes to squat or knee chest position
Loud, harsh, widely transmitted murmur or soft, scratchy, localized systolic murmur on left 2 nd, 3rd, 4th
parasternal space
Splitting of second heart sound
Thrill left sternal border

Test results
 Diagnostic Test Result
Chest X-Ray Decreased pulmonary vascular marking,
enlarged R ventricle, boot shaped cardiac
silhouette
Electrocardiography and R ventricular hypertrophy, R axis deviation, R
Atrial hypertrophy
Echocardiography VSD, septal overriding of Aorta, pulmonic
sterosis, R ventricle wall hypertrophy

Cardiac Catheterization Evaluation of the extent of defect (VSD and

pulmonic sterosis)

Laboratory
Polycythemia – increase Hgb, increase Hct, increase total REC count, decrease O2 saturation

Management
Administer Oxygen + knee chest position + morphine for Hypoxic episode (tet spells)
Propanolol (Beta Blocker) – to aid pulmonary artery dilation DOC : INDERAL
Palliative Surgical Repair - Blalock – Tavssig Procedure, subclavian artery is used, no palliative pulse in R arm
Surgery - to correct the heart defects (1-2 years old)
Full Repair – Brack procedure – relieves VSD, pulmo stenosis, overriding aorta