A client has a child diagnosed with Tetralogy of Fallot (TOF) and is concerned about the child’s symptoms.
Which of the following symptoms are characteristic of TOF?
A.
Cyanosis that worsens with crying or feeding.
B.
Severe chest pain.
C.
Palpitations.
D.
Frequent respiratory infections.
The correct answer and Explanation is :
The correct answer is A. Cyanosis that worsens with crying or feeding.
Explanation:
Tetralogy of Fallot (TOF) is a congenital heart defect characterized by four key abnormalities:
- Pulmonary stenosis – narrowing of the pulmonary valve or artery, which decreases blood flow to the lungs.
- Ventricular septal defect (VSD) – a hole between the heart’s lower chambers.
- Overriding aorta – the aorta is positioned over the VSD, allowing oxygen-poor blood to flow into the systemic circulation.
- Right ventricular hypertrophy – thickening of the right ventricle muscle due to the increased workload caused by the other defects.
Cyanosis, or bluish discoloration of the skin, occurs due to the mixing of oxygen-poor and oxygen-rich blood, which leads to decreased oxygen saturation. This is the hallmark symptom of TOF. The cyanosis typically worsens during episodes of increased oxygen demand, such as crying, feeding, or physical activity. These situations can precipitate “tet spells,” where the child may exhibit deepening cyanosis, difficulty breathing, irritability, and sometimes loss of consciousness due to sudden drops in oxygen levels. Parents may observe that the child becomes more cyanotic, especially around the lips and nails, during these episodes.
Severe chest pain (option B) and palpitations (option C) are not typical symptoms of TOF in infants and young children. These symptoms are more common in older individuals with acquired heart conditions or arrhythmias.
Frequent respiratory infections (option D) can occur in children with heart defects due to increased pulmonary congestion, but they are not specific to TOF and are more commonly associated with conditions that cause significant pulmonary overflow, such as ventricular septal defects without pulmonary stenosis.
In summary, cyanosis that worsens with crying or feeding (option A) is a primary characteristic of TOF and should alert caregivers to the severity of the defect.