re cases, important symptoms do not occur until later, when the child suffers exertional dyspnea (laboured breathing). Examination of the child reveals central cyanosis associated with physical underdevelopment and a mid-systolic ejection murmur is present in the pulmonary area. These symptoms were all present in the case of Charles William (appendix one) and were used in the diagnosis of his defect by Dr Wellbelove. A further symptom which may be observed in a child suffering tetralogy of fallot is 'squatting' after exercise. This is due to the falling of systemic vascular resistance. The act of squatting kinks the femoral arteries and acutely increases the systemic vascular resistance and so relieves the cyanosis.
             Atrial septal defect is an example of CHD that occurs more commonly in females than in males. It occurs if there is an error in the growth or development of the thin wall of tissue that is the first septum, which effectively divides the single atrial chamber into two, during the fifth week of gestation. If this error occurs, a communicati
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