Which auscultation findings are characteristic of tetralogy of Fallot (TOF)?

Updated: Nov 13, 2018
  • Author: Shabir Bhimji, MD, PhD; Chief Editor: Yasmine S Ali, MD, FACC, FACP, MSCI  more...
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Auscultation of the chest for pulmonary valve insufficiency will reveal a low-pitched, short diastolic murmur. This murmur is often difficult to hear in most individuals as it has a very short duration, even when the insufficiency is severe; thus the pathology may be missed on the physical examination. Some patients may have an extra heart sound—an ejection click as a result of a dilated ascending aorta. In addition, some patients may have a murmur due to aortic regurgitation.

If RV outflow tract obstruction is present, an audible murmur is usually noted. In addition, the presence of a residual ventricular septal defect will reveal a loud pansystolic murmur.

If the pulmonary valve insufficiency is not identified, it gradually leads to RV dysfunction and the onset of arrhythmias. The majority of adult patients with tetralogy of Fallot need corrective surgery to repair or replace the pulmonary valve.

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