Symptoms
Cyanosis (bluish skin, lips, and nails)
Shortness of breath and rapid breathing, especially during feeding or activity
Poor weight gain
Tiring easily during play or exercise
Irritability
Prolonged crying
Heart murmur
Clubbing of fingers and toes (less common in early infancy)
"Tet spells" (sudden episodes of deep cyanosis, often with loss of consciousness)
Causes
The exact cause of Tetralogy of Fallot is often unknown. However, several factors can increase the risk:
Genetic factors: Certain genetic syndromes, such as Down syndrome and DiGeorge syndrome, are associated with a higher risk of TOF.
Maternal factors: Certain maternal conditions during pregnancy, such as rubella (German measles), poor nutrition, alcohol use, certain medications, and advanced maternal age, may increase the risk.
Medicine Used
Medications are primarily used to manage symptoms before surgery or to treat complications after surgery. Common medications include:
Prostaglandin E1 (Alprostadil): Used to keep the ductus arteriosus open in newborns with severe cyanosis, allowing more blood to flow to the lungs before surgery.
Beta-blockers (e.g., Propranolol): Can help reduce the frequency and severity of tet spells by slowing the heart rate and relaxing the right ventricular outflow tract.
Diuretics (e.g., Furosemide): Used to manage fluid overload if heart failure develops.
Antibiotics: Given prophylactically before dental procedures or other invasive procedures to prevent endocarditis (infection of the heart lining).
Is Communicable
No, Tetralogy of Fallot is not communicable. It is a congenital heart defect, meaning it is present at birth and is not caused by an infection or transmitted from person to person.
Precautions
While Tetralogy of Fallot itself isn't preventable in many cases, some precautions can lower the risk:
Prenatal Care: Women should receive proper prenatal care, including vaccinations (especially against rubella) and avoid alcohol and harmful drugs during pregnancy.
Genetic Counseling: Families with a history of heart defects may benefit from genetic counseling.
Healthy Lifestyle: Maintaining a healthy lifestyle during pregnancy, including a balanced diet, can also help.
Preventing Endocarditis: After surgery, patients often need to take antibiotics before dental work or other procedures to prevent endocarditis.
How long does an outbreak last?
Tetralogy of Fallot is not an infectious disease; therefore, it does not have outbreaks.
How is it diagnosed?
Physical Exam: A doctor may suspect TOF based on symptoms like cyanosis and a heart murmur.
Echocardiogram: This is the primary diagnostic tool. It uses sound waves to create an image of the heart's structure and function, showing the VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy.
Electrocardiogram (ECG/EKG): Records the electrical activity of the heart and can show signs of right ventricular hypertrophy.
Chest X-ray: Can show the size and shape of the heart and lungs, sometimes revealing a "boot-shaped" heart, which is characteristic of TOF.
Pulse oximetry: Measures the oxygen saturation in the blood.
Cardiac Catheterization: In some cases, this invasive procedure may be needed to further evaluate the heart's structures and pressures.
Timeline of Symptoms
Infancy: Cyanosis is often present at birth or develops within the first few months of life. Shortness of breath and feeding difficulties may also be noticeable. "Tet spells" can occur.
Childhood: If the defect isn't corrected early, symptoms like fatigue, poor growth, and exercise intolerance become more apparent. Clubbing of fingers and toes can develop over time.
Adulthood: Uncorrected TOF can lead to serious complications like heart failure, arrhythmias, and stroke. Surgical correction typically leads to improved health and lifespan, but ongoing monitoring is still necessary.
Important Considerations
Surgical Repair: Early surgical repair is crucial to improve the quality of life and lifespan of individuals with Tetralogy of Fallot.
Lifelong Follow-up: Even after successful surgery, patients need lifelong follow-up care with a cardiologist to monitor for potential complications and manage any residual issues.
Endocarditis Prophylaxis: Patients may need antibiotics before certain dental or surgical procedures to prevent endocarditis.
Exercise and Activity: Discuss appropriate exercise and activity levels with the cardiologist.
Pregnancy: Women with repaired TOF should consult with their cardiologist before becoming pregnant to assess their risk and manage their care during pregnancy.
Psychosocial Support: Support groups and counseling can be helpful for patients and families coping with the challenges of living with a congenital heart defect.