Tetralogy of Fallot
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: Q21.3 DESCRIPTION Ventricular septal defect with aortic override, right ventricular outflow tract obstruction and right ventricular hypertrophy. Suspect tetralogy of Fallot in a child with cyanosis after the neonatal period. DIAGNOSTIC CRITERIA Clinical Child with central cyanosis. May b
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: Q21.3
DESCRIPTION
Ventricular septal defect with aortic override, right ventricular outflow tract obstruction and right ventricular hypertrophy.
Suspect tetralogy of Fallot in a child with cyanosis after the neonatal period.
DIAGNOSTIC CRITERIA
Clinical
- Child with central cyanosis.
- May be plethoric due to polycythemia – normal haemoglobin represents relative anaemia.
- May have clubbing.
- Possible history of cyanotic spells.
- Heart not clinically enlarged.
- Right ventricular hypertrophy usually not palpable.
- Single second heart sound.
- Coarse, ejection systolic murmur over right ventricular outflow tract.
- Chest X-ray:
- normal/small heart,
- boot shaped/pulmonary bay – concavity where pulmonary artery should be,
- oligaemic lung fields.
- ECG:
- right axis deviation and right ventricular hypertrophy.
GENERAL AND SUPPORTIVE MEASURES
- Good dental hygiene.
MEDICINE TREATMENT
- Iron (elemental), oral, 1 mg/kg/dose 8 hourly.
- Folic acid, oral, 2.5– 5 mg/day.
- Propranolol, oral, 0.5–1 mg/kg/dose 6 hourly.
- Do not exceed 5 mg/kg/day.
Endocarditis prophylaxis:
See: Endocarditis, infective.
REFERRAL
- Refer all children with cyanotic heart defects.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 4: Cardiovascular System , 4.2 Congenital Heart Disease (CHD), 4.2.2 Tetralogy of Fallot