Tetralogy of fallot physical examination: Difference between revisions
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{{Tetralogy of fallot}} | {{Tetralogy of fallot}} | ||
{{CMG}}; '''Associate Editors-In-Chief:''' {{Fs}}, [[Priyamvada Singh| Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com], [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] | |||
==Overview== | ==Overview== | ||
==Physical examination== | Patients with tetralogy of Fallot usually appear small due to a [[failure to thrive]]. [[Physical examination]] of [[patients]] with tetralogy of Fallot is usually remarkable for [[cyanosis]], [[systolic]] [[Palpation of the precordium|thrill]], [[systolic ejection murmur]], and [[Clubbing]]. | ||
*As RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect. This causes the pulmonic murmur to become shorter and softer. P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis. | ==Physical Examination== | ||
* | |||
* | ===Appearance of the Patient=== | ||
* Patients with tetralogy of Fallot usually appear small due to a [[failure to thrive]] | |||
== | *Patients may be found in squatting position (compensatory mechanism) | ||
* [[ | |||
* | ===Vital Signs=== | ||
*[[Tachycardia]] with regular pulse | |||
*Tachypnea | |||
===Skin=== | |||
* [[Cyanosis]] may be present | |||
===HEENT=== | |||
* Retinal vessels engorgement may be present | |||
=== Neck === | |||
* Neck examination of patients with tetralogy of Fallot is usually normal. | |||
=== Lung === | |||
* Pulmonary examination of patients with tetralogy of Fallot is usually normal. | |||
===Heart=== | |||
* A [[thrill]] may be present at left sternal border. | |||
* A right ventricular impulse may be prominent. | |||
* First heart sound ([[S1]]) is normal | |||
* Second heart sound ([[S2]]) is single as [[P2]] is absent. | |||
* A harsh [[systolic ejection murmur]] best heard at the left sternal border is usually present. | |||
*The loudness and length of [[systolic murmur]] is inversely proportional to the severity of [[right ventricular outflow tract obstruction]] ([[RVOTO]]). | |||
*In other words as the RVOTO worsens, the murmur softens. | |||
*The more cyanotic the patient, the softer the murmur. | |||
* As the [[RVOTO]] progresses towards occlusion the right ventricular blood is diverted to left ventricle through [[ventricular septal defect]]. | |||
*This causes the pulmonic murmur to become shorter and softer. | |||
*[[P2]] is faint and delayed in mild [[cyanosis]] and inaudible in severe [[cyanosis]]. | |||
* A diastolic murmur may be heard due to [[aortic regurgitation]]. | |||
=== Abdomen === | |||
* Abdominal examination of patients with tetralogy of Fallot is usually normal. | |||
===Extremities=== | |||
* [[Clubbing]] | |||
* [[Cyanosis]] is most prominent at [[lip]]s and nail beds | |||
==References== | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Fahimeh Shojaei, M.D., Priyamvada Singh, M.B.B.S. [2], Keri Shafer, M.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]
Overview
Patients with tetralogy of Fallot usually appear small due to a failure to thrive. Physical examination of patients with tetralogy of Fallot is usually remarkable for cyanosis, systolic thrill, systolic ejection murmur, and Clubbing.
Physical Examination
Appearance of the Patient
- Patients with tetralogy of Fallot usually appear small due to a failure to thrive
- Patients may be found in squatting position (compensatory mechanism)
Vital Signs
- Tachycardia with regular pulse
- Tachypnea
Skin
- Cyanosis may be present
HEENT
- Retinal vessels engorgement may be present
Neck
- Neck examination of patients with tetralogy of Fallot is usually normal.
Lung
- Pulmonary examination of patients with tetralogy of Fallot is usually normal.
Heart
- A thrill may be present at left sternal border.
- A right ventricular impulse may be prominent.
- A harsh systolic ejection murmur best heard at the left sternal border is usually present.
- The loudness and length of systolic murmur is inversely proportional to the severity of right ventricular outflow tract obstruction (RVOTO).
- In other words as the RVOTO worsens, the murmur softens.
- The more cyanotic the patient, the softer the murmur.
- As the RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect.
- This causes the pulmonic murmur to become shorter and softer.
- P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.
- A diastolic murmur may be heard due to aortic regurgitation.
Abdomen
- Abdominal examination of patients with tetralogy of Fallot is usually normal.
Extremities