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PANCE® is a registered trademark of the National Commission on Certification of Physician Assistants (NCCPA). This application is an independent study resource and is not affiliated with, sponsored by, or endorsed by the NCCPA.

For educational use only. Content is AI-generated, may contain errors, and is not medical advice — always verify against current primary sources and faculty guidance before clinical use.

HomeCardiovascularTetralogy of Fallot
🫀

Tetralogy of Fallot

Cardiovascular · ~11% of blueprint
🔬Pathophysiology
Most common cyanotic congenital heart disease. Four features: pulmonary stenosis, RV hypertrophy, overriding aorta, VSD. RVOT obstruction → right-to-left shunt → cyanosis.
🩺Signs & Symptoms
Cyanosis; 'tet spells' (hypercyanotic episodes relieved by squatting); systolic ejection murmur from pulmonary stenosis; digital clubbing.
🎯Gold Standard Diagnosis
Echocardiography. CXR: 'boot-shaped' heart (coeur en sabot).
💊First-line Treatment
Surgical repair. Acute tet spell: knees-to-chest/squat, oxygen, IV fluids, beta-blocker, phenylephrine.
Drug cardsMetoprolol
High-Yield Pearl

Most common cyanotic congenital defect — PROVe: Pulmonary stenosis, RVH, Overriding aorta, VSD. Squatting ↑afterload → ↓right-to-left shunt, relieving tet spells. Boot-shaped heart on CXR.

Sources

Reviewed September 2026
  1. 2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the Management of Adults With Congenital Heart Disease — ACC/AHA/HRS/ISACHD/SCAI, 2025
  2. StatPearls: Tetralogy of Fallot — NCBI Bookshelf / StatPearls, 2025

Checked against the guideline or standard reference the exam keys to. If it has moved, use Report an error below.

More Cardiovascular conditions

  • Acute Coronary Syndrome (STEMI)
  • Acute Pericarditis
  • Aortic Dissection
  • Aortic Stenosis
  • Atrial Fibrillation
  • Deep Vein Thrombosis
  • Heart Failure (HFrEF)
  • Hyperlipidemia
  • Hypertension (Essential)
  • Hypertrophic Cardiomyopathy
  • Infective Endocarditis
  • Mitral Regurgitation
All Cardiovascular