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In a patient with tetralogy of Fallot, auscultation detects a loud systolic heart murmur (best heard along the left sternal border), which may diminish or obscure the pulmonic component of S2. In a patient with a large patent ductus, the continuous murmur of the ductus obscures the systolic murmur. Palpation may reveal a cardiac thrill at the left sternal border and an obvious right ventricular impulse. The inferior sternum appears prominent.
The results of special tests also support the diagnosis:
❑ Chest X-ray may demonstrate decreased pulmonary vascular marking, depending on the pulmonary obstruction’s severity, and a boot-shaped cardiac silhouette.
❑ Electrocardiography shows right ventricular hypertrophy, right axis deviation and, possibly, right atrial hypertrophy.
❑ Echocardiography identifies septal overriding of the aorta, the VSD, and pulmonary stenosis and detects the hypertrophied walls of the right ventricle.
❑ Laboratory findings reveal diminished arterial oxygen saturation and polycythemia (hematocrit may be more than 60%) if the cyanosis is severe and long-standing, predisposing the patient to thrombosis.
Source: Professional Guide to Diseases (Eighth Edition), 2005
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