cyanosis, which in severe cases is present at birth. However, in most cases over the first year or so of life there is hypertrophy of the infundibulum and increasing ventricular obstruction, with developing cyanosis. The infant may present with a large left to right shunt and heart failure.
squatting
paroxysmal hypercyanotic attacks
substernal right ventricular impulse
pan or ejection systolic murmur due to turbulence over the right ventricular outflow tract; heard at the back also
diastolic murmur may be present due to enlarged bronchial collateral vessels or patent ductus
the second heart sound is single and loud
delayed growth and development in untreated cases; this is proportional to the degree of cyanosis
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