Congenital Abnormalities

Tetralogy of Fallot

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This is an example of Tetralogy of Fallot heard at the tricuspid position.

Tetralogy of Fallot is a congenital condition often called Blue Baby Syndrome. It is characterized by four abnormalities:

- pulmonic stenosis

- increased thickening of the right ventricle

- a ventricular septal defect

- overriding aorta

The first and second heart sounds are normal and unsplit. There is an aortic ejection click in systole. There is a diamond shaped murmur following the click and ending well before the second heart sound.

In the anatomy tab you can see turbulent flow from the right ventricle into the pulmonary artery across the stenotic pulmonic valve and turbulent flow from the left ventricle to the right ventricle (the ventricular septal defect). The right ventricular wall is thickened.

If you listen at the tricuspid position you are hearing the ventricular septal defect. If you listen at the pulmonic area you are hearing the pulmonic stenosis. Both create diamond shaped systolic murmurs.

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The recommended auscultation position for the stethoscope is the Tricuspid position. For this sound, use stethoscope's Diaphragm.

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The recommended patient position is Supine

Phonocardiogram

This waveform plots sound amplitude on the vertical axis against time on the horizontal axis.

Heart Animation

Lessons

Coarctation of the Aorta
Patent Ductus Arteriosus
Atrial Septal Defect
Ventricular Septal Defect
Tetralogy of Fallot
Ebstein's Anomaly

Practice Drill

Listening Tips
A synopsis of important sound features and timing for this abnormality.
Systole: Aortic ejection click then a short diamond shaped murmur.
S2: May be partially masked by systolic murmur.

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