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== | ||
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]]. | |||
==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