Tetralogy of fallot physical examination: Difference between revisions
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{{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh| Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org], [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@perfuse.org] | {{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh| Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org], [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@perfuse.org] | ||
==Overview== | ==Overview== | ||
Tetralogy of Fallot is associated with cyanosis, clubbing, a thrill and a harsh systolic ejection murmur over the left sternal border. | Tetralogy of Fallot is associated with cyanosis, clubbing, a thrill and a harsh systolic ejection murmur over the left sternal border. | ||
| Line 9: | Line 10: | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*The patient may be small due to a failure to thrive | * The patient may be small due to a failure to thrive. Patients may be found in [[squatting]] position (compensatory mechanism). | ||
===Skin=== | ===Skin=== | ||
*[[Cyanosis]] | * Central [[Cyanosis]] may be present. Cyanosis most prominent at lips and nail beds. | ||
===Eyes=== | ===Eyes=== | ||
*Retinal engorgement may be present | * Retinal engorgement may be present. | ||
===Heart=== | ===Heart=== | ||
===Palpation=== | ====Palpation==== | ||
*A [[thrill]] may be present at left sternal border. | * A [[thrill]] may be present at left sternal border. | ||
* | * A right ventricular impulse may be prominent. | ||
===Auscultation=== | ====Auscultation==== | ||
* | * First heart sound ([[S1]]) is normal | ||
*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. | * Second heart sound ([[S2]]) is single as [[P2]] is absent. | ||
*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 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. | ||
* A diastolic murmur may be heard due to [[aortic regurgitation]] | * 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]]. | |||
===Extremities=== | ===Extremities=== | ||
Revision as of 16:19, 24 October 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2], Keri Shafer, M.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]
Overview
Tetralogy of Fallot is associated with cyanosis, clubbing, a thrill and a harsh systolic ejection murmur over the left sternal border.
Physical Examination
Appearance of the Patient
- The patient may be small due to a failure to thrive. Patients may be found in squatting position (compensatory mechanism).
Skin
- Central Cyanosis may be present. Cyanosis most prominent at lips and nail beds.
Eyes
- Retinal engorgement may be present.
Heart
Palpation
- A thrill may be present at left sternal border.
- A right ventricular impulse may be prominent.
Auscultation
- 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.