Which symptom is NOT associated with tetralogy of Fallot?

Tetralogy of Fallot is a congenital heart defect that involves four key anomalies: ventricular septal defect (VSD), pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. The symptoms associated with this condition can vary in severity, primarily depending on the degree of pulmonary stenosis.

Cyanosis is a classic symptom due to inadequate oxygenation of the blood, which occurs in tetralogy of Fallot when there is a right-to-left shunt at the ventricular level. As a result, children often present with a bluish tint to the skin, particularly during episodes of exertion. Clubbing of the fingers and toes is another symptom that can develop over time due to chronic hypoxia, as it is a sign of prolonged oxygen deprivation.

Children with tetralogy of Fallot may also experience "tet" spells, which are episodes of acute cyanosis and shortness of breath that can occur during crying or exertion. Squatting is a compensatory mechanism that helps relieve these spells; it increases systemic vascular resistance and reduces the right-to-left shunting, allowing more blood to flow to the lungs for oxygenation.

In contrast, being asymptomatic is not characteristic of tetralogy of Fallot when symptoms are usually