A 75-year-old man presented to the cardiology clinic with complaints of exertional dyspnea, clubbing of the fingers and cyanosis. He was diagnosed with congenital heart disease at birth, however, the diagnosis of TOF was not until his adolescence. He was asymptomatic for most of his childhood and only experienced cyanosis and dyspnea when physically overworked. Although, he became symptomatic in his 50s with cyanosis and progressive dyspnea on exertion.
He was first assessed at the hospital at 70 years of age, when he was brought in for aggravated chronic heart failure because of new onset atrial fibrillation. At presentation, he appeared cachectic and fatigued, however, was alert. He clubbing of the fingers and toes, central cyanosis, pectus carinatum and mild kyphosis. His pulse was 77 beats per minute and respiratory rate 22 breaths per minute. Blood pressure was 100/66 mm Hg and oxygen saturation 88% while the patient was breathing 2 L of oxygen via a nasal cannula. The partial pressure of oxygen and carbon dioxide was 53 mm Hg and 30 mm Hg.
Electrocardiography of the patient showed incomplete right bundle branch block with QRS duration of 100 m.s, biventricular hypertrophy, right axis deviation and atrial fibrillation. In addition, subpulmonic stenosis, right ventricular hypertrophy and aorta overriding a large ventricular septal defect. The findings were consistent with the diagnosis of tetralogy of fallot.
Tetralogy of fallot is a rare congenital abnormality that is caused by a combination of four heart defects. The defects affect the structure of the heart and cause oxygen-poor blood to flow from the heart to the rest of the body. Children with this defect often have blue-tinged skin because the blood doesn’t carry enough oxygen. Depending on the severity of symptoms, the condition is often diagnosed during infancy or soon after. However, in this case, it was not detected until later in life.
The patient refused any surgical treatment or invasive procedures because of his religious beliefs. Therefore, he was treated with acenocoumaral, spironolactone, digoxin and furosemide. He was discharged from the hospital after a week.
References
Stanescu, C. M., & Branidou, K. (2008). A case of 75-year-old survivor of unrepaired tetralogy of Fallot and quadricuspid aortic valve. European Journal of Echocardiography, 9(1), 167-170.
