Pathologic Findings of Some Common Congenital Cardiac Defects Heart Murmurs Continued

Congenital Defect

Tetralogy of Fallot

With pulmonic stenosis iiiim IIIII

With pulmonic atresia

Mechanism

Characteristics of the Murmur Associated Findings

Complex defect with ventricular septal defect, infundibular and usually valvular right ventricular outflow obstruction, mal-rotation of the aorta, and right-to-left shunting at ventricular septal level.

General. Variable cyanosis, increasing with activity

Location. Mid-to-upper left sternal border. If pulmonary atresia, there is no systolic murmur but the continuous murmur of ductus arteriosus flow at upper left sternal border or in the back.

Radiation. Little, to upper left sternal border, occasionally to lung fields

Intensity. LTsually Grade III-IV

Qitality. Midpeaking, systolic ejection

Normal pulses

The pulmonary closure sound is usually not heard. May have abrupt hypercyanotic spells with sudden increase in cyanosis, air hunger, altered level of awareness

Failure to gain weight with persistent and increasingly severe cyanosis

Long-term persistence of cyanosis accompanied by clubbing of fingers and toes

Persistent hypoxemia leads to polycythemia, which will accentuate the cyanosis.

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