A classic

There are 4 murmur characteristics described and tetra logy of fallot has 4 problems (PROVe)

1. P ulmonary infundibular stenosis
2. R V hypertrophy
3. O verriding aorta
4. V SD --> holosystolic murmur + mid-diastolic at apex (due to increased MV flow) + thrill (in small VSD due to turbulence)

Single S1 from reduced pulmonic component (remember, MTAP, MT = S1, AP = S2)

• Infant/toddler with early cyanosis and clubbing with murmur consistent with RV hypertrophy (RV heave), Pulmonic stenosis (single S2), and a VSD (systolic murmur), which are 3/4 of the features of Tetralogy of Fallot
• Key idea: Causes of early cyanosis from primary heart defects can be remembered with mnemonic 1, 2, 3, 4 and 5 because it can be caused by (1) persistent truncus arteriosus (1 vessel) (2) transposition of the great vessels (2 switched vessels) (3) Tricuspid atresia (Tri = 3) (4) Tetralogy of Fallot (Tetra = 4) (5) Total anomalous pulmonary venous return (5 letters in name)