As a nurse, I've listened to my own kids hearts, and since the initial diagnoses of Piper's murmur, I've noted that it's not only gotten louder, it's arrhythmic... and I"ve noted over the last 9 months or so that she squats when she's "tired". I know what this can be indicative of, and I found the following to make me all the more concerned:
Tetralogy of Fallot constitutes 4%-9% of congenital heart disease and is the most common cyanotic congenital heart disease when considering all age groups together. Tetralogy of Fallot and pulmonary atresia with ventricular septal defect consist of: a) ventricular septal defect, b) pulmonary stenosis, c) overriding of the aorta, and d) right ventricular hypertrophy. Approximately 25% have a right-sided aortic arch, and about 4% have a coronary artery anomaly. The degree of cyanosis depends on the degree of pulmonic outflow obstruction. This is quite variable, from a slight obstruction, to severe obstruction with pulmonary atresia. Pulmonary atresia constitutes about 18% of the children with tetralogy of Fallot (3). The major right ventricular outflow obstruction in tetralogy of Fallot is infundibular stenosis. With mild stenosis, there may be congestive heart failure in infancy, also known as "pink tetralogy of Fallot." As infundibular stenosis increases, progressive cyanosis develops (due to less pulmonary blood flow), and infants and children may develop cyanotic or hypoxic spells, which consist of sudden onset of increased cyanosis, excessive crying, hypoxemia, acidosis, dyspnea, fainting, rarely seizures, and occasionally death if untreated. During these episodes (called "Tet" spells), there is increased right-to-left shunting (with less pulmonary flow), and decreased systemic vascular resistance. Older infants and children may assume a squatting position during playtime or long walks which increases systemic vascular resistance and decreases right to left shunting, increasing their oxygenation.From: http://www.hawaii.edu/medicine/pediatrics/pedtext/s07c03.html
Needless to say I'm anxious for the check up that Piper has next week with the pediatrician.