VENTRICULAR SEPTAL DEFECT

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Last Updated : 1/12/2010
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N C Joshi
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Small VSD: asymptomatic. Spontaneous closure occurs in 40-50% by 3 years of age
Large VSD: CHF at 2-3 months of age. Diastolic rumble is usually heard.

Physical Examination:
- Poor weight gain
- Systolic thrill with holosystolic murmur at LLSB
- Diastolic murmur with large shunts and loud P2 with pulmonary hypertension

Figure 2: Cardiac findings of a small VSD.
A regurgitant systolic murmur is best audible at the LLSB; it may be holosystolic or less than holosystolic. Occasionally, the heart murmur is in early systole. A systolic thrill (Dots) may be palpable at the LLSB. The S2 splits normally and the P2 is of normal intensity.



Figure 3: Cardiac findings of a large VSD.
A classic holosystolic regurgitant murmur is audible at the LLSB. A systolic thrill is also palpable at the same area (dots). There is usually a middiastolic rumble (due to relative mitral stenosis) at the apex. The S2 is narrowly split and the P2 is accentuated in intensity. Occasionally an ejection click (EC) may be audible in the ULSB when associated with pulmonary hypertension. The heart murmurs shown without solid borders are those murmurs that are transmitted from other areas and are not characteristic of the defect. Abnormal sounds are shown in black.





Contributor Information and Disclosures N C Joshi
Consultant Pediatrician, Nanavati Hospital, Mumbai, India


First Created : 1/8/2001
References
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