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

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

Waveform (Phonocardiogram)

Observe

//embedding heart animation

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

These authors contributed the audio recordings and text found in this reference guide: Jon Keroes, MD,Diane Wrigley, PA, and David Lieberman.
Medically reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.

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