Tetralogy of fallot physical examination


 * Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org], Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Tetralogy of Fallot is associated with cyanosis, clubbing, a thrill and a harsh systolic ejection murmur over the left sternal border.

Appearance of the Patient

 * The patient may be small due to a failure to thrive

Skin

 * Cyanosis which is central

Eyes

 * Retinal engorgement may be present

Palpation

 * A thrill may be present
 * An RV predominance may be palpated

Murmur

 * 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

Extremities

 * Clubbing