Tetralogy of Fallot is a congenital heart defect that involves the following 4 chambers of the heart and the vessels of the heart.
- Ventricle – there is a hole in the ventricles also called a ventricular septal defect.
- Aorta – aortic valve is bigger than the normal heart. It sits right up the ventricular septal defect like it is not in the right place, also known as aortic displacement or overriding aorta.
- Pulmonary artery – this artery appears to be narrow, this condition is known as pulmonary stenosis.
- Right Ventricle – the right ventricle is compacted otherwise known as right ventricular hypertrophy.
Notes to remember about TOF:
This is considered a critical congenital heart defect by the CDC. It develops during fetal development. According to CDC.gov, 1 in 2518 babies that are born have TOF in the United States.
- The baby has bluish skin color – cyanotic. They may show signs of bluish coloration when they are crying or having a meal, also called tet spells.
- Children with TOF may develop endocarditis or infection in the heart layers.
- The heart rhythms are irregular also called arrhythmia.
- Children may be feeling dizzy most of the time that they may faint or sometimes they may show signs of seizures because of low oxygen levels in the blood.
- Due to the low supply of oxygenated blood in their body, children with TOF experience delayed growth and development.
Normal Blood Flow
In the normal blood flow, the deoxygenated blood travels from the body to the heart, then to the lungs to be oxygenated, and then back to the heart then to the body.
Blue blood (deoxygenated blood) from the body enters the right atrium then passes through the tricuspid valve which enters through the right ventricle then passes through the pulmonary valve (low pressure); after that, it passes through a pulmonary artery which enters the lungs to get oxygen.
Red blood (oxygenated blood) will return to the left side of the heart then passes along the pulmonary veins then to the left atrium, then passes through the mitral valve which enters via the left ventricle that pumps blood to the body which passes through the aortic valve through the aorta, delivering blood to the whole body.
Tetralogy of Fallot Blood Flow
The normal blood circulation is impeded due to the obstruction in the ventricles and the pulmonary valve is also narrowed. This results in cyanosis or the bluish discoloration of the skin and the extremities.
Signs and Symptoms
- Murmur
- Cyanosis
- Rapid breathing
- A sudden drop in oxygen saturation
- Irritable
- Sleepy or unresponsive when severe cyanosis persists
- Tetralogy spell
Diagnosis
- Pulse oximetry
- Electrocardiogram (ECG or EKG)
- Chest x-ray
- Cardiac catheterization
Treatment
- Medication – Medical therapy is not required before surgery. However, to treat ductal patency in cyanosis that is severe, medication is needed. Interventions that can be used are:
- Beta-blockers
- Alpha-1 agonists
- Vasodilators
- Diuretics
- Surgery
- Intracardiac repair
- Temporary shunt repair
Nursing Intervention
- Check signs of infection – increased white blood cell count, pulse rate is increased and respiration too
- Reduce the exposure with other kids to avoid infection
- Hand washing before and after patient care
- Give enough rest and good nutritional food
- When an intravenous line is on, a sterile technique should be practiced
- Medication for infection should be administered as ordered
- Instruct the parents about the need of maintaining good personal hygiene
