Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of cyanotic spells (Tet spells), exertional dyspnea, and squatting behavior. Clinical features include progressive cyanosis, clubbing of digits, and failure to thrive. History significant for known diagnosis of Tetralogy of Fallot (Q21.3) with recent episodes of hyperpnea and irritability.
Clinical Examination Findings
General appearance: Cyanosis noted in mucous membranes and nail beds. Cardiovascular: Grade III/VI harsh systolic ejection murmur heard best at the left mid-to-upper sternal border (pulmonary stenosis). Single S2 heart sound. Extremities: Digital clubbing present; capillary refill >3 seconds. Peripheral pulses are symmetric.
Treatment Protocol
Management plan: Immediate administration of oxygen and knee-to-chest positioning for hypercyanotic spells. Pharmacological intervention with IV fluids, beta-blockers (propranolol) to reduce infundibular spasm, and morphine sulfate if indicated. Surgical consultation for definitive total repair (VSD closure and RVOT reconstruction).