Tetralogy of Fallot

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 video 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.

Auscultation Sounds

Position

The patient's position should be supine.

Listening Tips for Tetralogy of Fallot

Systole:Aortic ejection click then a short diamond shaped murmur
S2:May be partially masked by systolic murmur

Waveform (Phonocardiogram)

Observe Cardiac Animation for Tetralogy of Fallot

Observe 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.

Authors and Sources

Authors and Reviewers

EKG heart rhythm modules: Thomas O'Brien.
EKG monitor simulation developer: Steve Collmann
12 Lead Course: Dr. Michael Mazzini, MD.
Spanish language EKG: Breena R. Taira, MD, MPH
Medical review: Dr. Jonathan Keroes, MD
Heart sounds and mentorship: W. Proctor Harvey, MD
Medical review: Dr. Pedro Azevedo, MD, Cardiology
Last Update: 1/8/2023

Sources

Electrocardiography for Healthcare Professionals, 5th Edition Kathryn Booth and Thomas O'Brien
ISBN10: 1260064778, ISBN13: 9781260064773
McGraw Hill, 2019
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Aaron Reed
Create Space Independent Publishing
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN
Clinical Heart Disease W Proctor Harvey, MD
Clinical Heart Disease
Laennec Publishing; 1st edition (January 1, 2009)
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429
Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH

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Tetralogy of Fallot | Lessons with Audio and Video | #112