Tetralogy of Fallot's present with one of the following:

Ans. is 'a' i.e. . Central cyanosis with clubbing. TOF is the commonest cyanotic congenital* heart disease in children above the age of 2 years.The four constituents of Tetralogy are :Ventricular septal defect*Pulmonic stenosis*Overriding of dextroposed Aorta *Right ventricular hypertrophy *Physiologically the pulmonary stenosis causes concentric right ventricular hypertrophy without cardiac enlargement. When the right ventricular pressure is as high as the left ventricular or the aortic through the VSD. Since right ventricle is effectively decompressed by V.S.D. congestive cardiac failure never occurs in TOF*Right ventricular hypertrophy in E.C.G. reflected by Right axis deviation*.The flow from the right ventricle into the pulmonary artery occurs across the pulmonary stenosis producing an ejection systolic murmur*.Clinical features of TOF :Cyanosis usually presents after neonatal period*Hypoxemic or cyanotic spells* (Tet spells)*Commonest congenital lesion with which squatting* is usedClubbing*Auscultatory findings :s1-Normals2-Single predominantly AorticMurmur-Ejection systolic* TOF patients are RARELY CYANOTIC AT BIRTH*Chest x-rayNormal heart size *Oligemic lung fields*Right aortic arch present in 25% caseECG - Right axis deviation*