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Tetralogy of Fallot Signs 6/2/11 Talley and O’Connor - cyanotic congenital heart disease PATHOLOGY (1) (2) (3) (4) VSD right ventricular outflow tract obstruction an over-riding aorta (overrides the VSD and is responsible for the cyanosis) right ventricular hypertrophy secondary to outflow tract obstruction SIGNS Central cyanosis (mixing at the ventricular level) Clubbing Polycythaemia ESM or PSM Right ventricular heave (right ventricular enlargement) Systolic thrill (pulmonary valve or right ventricular outflow tract obstruction) A loud single heard sound Jeremy Fernando (2011)