The Foley Family is caring for their youngest child, Justin, who is suffering from tetralogy of Fallot. Which of the following are defects associated with this congenital heart condition?

Decreased cardiac output is a common consequence of various cardiac conditions in children. In this scenario, the child's cool extremities and thready pulses indicate poor peripheral perfusion, which can occur when the heart is not effectively pumping blood to meet the body's demands. Decreased urinary output is another sign of poor cardiac output, as reduced blood flow to the kidneys can result in decreased urine production.

The other options may contribute to decreased cardiac output, but they are not the primary factors indicated by the clinical findings:

A. Increased afterload: Increased afterload can make it more difficult for the heart to pump blood effectively, but it is not the primary cause of the symptoms described.

C. Decreased contractility: Decreased contractility can reduce the heart's ability to pump blood, contributing to decreased cardiac output, but it is not the primary factor indicated by the clinical findings.

D. Increased stroke volume: An increase in stroke volume typically results in improved cardiac output, not diminished cardiac output as seen in this scenario.

Tetralogy of Fallot is a congenital heart defect characterized by four specific abnormalities:

Ventricular septal defect (VSD): This is a hole in the wall (septum) between the two lower chambers (ventricles) of the heart.

Overriding aorta: The aorta is positioned over both the left and right ventricles, which allows oxygen-poor (deoxygenated) blood from the right ventricle to be pumped into the aorta and to the body.

Pulmonic stenosis (PS): This is a narrowing of the pulmonary valve or artery that restricts blood flow from the right ventricle to the lungs.

Right ventricular hypertrophy: The right ventricle becomes thicker and more muscular as it works harder to pump blood against the narrowed pulmonary valve or artery.

Options A, C, and D describe different congenital heart conditions and defects, but they are not associated with Tetralogy of Fallot:

A. Coarctation of aorta, aortic valve stenosis, mitral valve stenosis, and patent ductus arteriosus are not part of the constellation of defects seen in the Tetralogy of Fallot.

C. Describing the aorta exiting from the right ventricle and pulmonary artery exiting from the left ventricle with two noncommunicating circulations is characteristic of transposition of the great arteries, not Tetralogy of Fallot.

D. Tricuspid valve atresia, atrial septal defect, ventricular septal defect, and hypoplastic right ventricle describe a different congenital heart condition, not Tetralogy of Fallot.