Ventricular septal defect physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Priyamvada Singh, MBBS; Keri Shafer, M.D. [2]; Leida Perez, M.D.

Overview

The physical examination findings of a ventricular septal defect depend upon the size of the defect, the location of the defect, the magnitude and directionality of the intracardiac shunt, and the age of the patient (the duration of the VSD).

Children

Small VSD

Medium-Sized VSD

Large-Sized VSD with Pulmonary Obstructive Disease

  • The features are similar to those seen in a medium-sized VSD.
  • In the first 2 years of life, the patient may have signs of left sided volume overload. After the age of 2 years, the patient have exhibit signs and symptoms of progressive pulmonary vascular obstructive disease (pulmonary hypertension. As a consequence, poor growth may be present and the left anterior thorax may bulge outward.
  • The JVP may be elevated due to right ventricular failure.
  • In the first two years of life there may be a prominent LV impulse or heave, but with the development of pulmonary hypertension, this LV prominence is diminished and cyanosis may be present which worsens with effort and with time.

Adults

Small VSD

  • May be asymptomatic with no signs or symptoms
  • Holosystolic murmur heard best at left sternal border in the 3rd and 4th intercostal space

Moderate VSD

  • A displaced cardiac apex may be present.
  • A harsh holosystolic murmur at 3rd to 4th intercostal space to left side of sternum may be present.
  • A rumbling mid-diastolic murmur at cardiac apex suggesting increase flow across the mitral valve.
  • A midsystolic ejection murmur due to increased flow across the pulmonary valve may be present.

Large VSD

Large VSD may progress to Eisenmenger syndrome. Physical examination may reveal-

Video Examples of Physical Examination Findings

In first video one can appreciate the normal heart sound. On careful listening one can appreciate the S1 and S2 (lub-dub) <youtube v=xS3jX1FYG-M/>

In the second video one can appreciate that the first and second heart sounds are not audible and a murmur that covers the whole systole is there. This is characteristic holosystolic murmur of ventricular septal defect <youtube v=7oKz6J0Ay_I/>

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