Ventricular septal defect physical examination
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Differentiating Ventricular Septal Defect from other Diseases | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]and Leida Perez, M.D.
Associate Editor-In-Chief: Keri Shafer, M.D. [2], Priyamvada Singh, MBBS
Physical Examination [1]
Small VSD:
A systolic thrill may be palpable along the left sternal border and a loud holosystolic murmur (harsher quality than that of MR)localized to the left lower sternal border. In patients with small muscular defects, the murmur may end in mid systole because of systolic contraction of the septal musculature.
Medium-Sized VSD:
The rare patient who presents with a medium-sized defect or a moderate left-to-right shunt also may have a third heart sound (S3) and a short early middiastolic rumble due to increased left-sided volume overload.
Large-Sized VSD with Pulmonary Obstructive Disease:
In the first 2 years of age the patients have signs of left sided volume overload. After age 2 old, the patients have signs and symptoms of progressive pulmonary vascular obstructive disease. As a consequence, poor growth and left anterior thorax may bulge outward early. JVD may be elevated due to RV failure.
In the first two years there is a prominent LV impulse, but with the development of pulmonary hypertension, this LV prominence is diminished and cyanosis is present, worsens with effort and with time.
Example of VSD murmur: Media:VSD murmur.mp3
References
- ↑ Braunwald Zipes Libby. Heart disease: A textbook of cardiovascular medicine, 6th Edition chapter 43:W.B. Saunders ;.pp 1533