Ventricular septal defect physical examination: Difference between revisions
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==Physical Examination <ref> Braunwald Zipes Libby. Heart disease: A textbook of cardiovascular medicine, 6th Edition chapter 43:W.B. Saunders ;.pp 1533</ref> == | ==Physical Examination <ref> Braunwald Zipes Libby. Heart disease: A textbook of cardiovascular medicine, 6th Edition chapter 43:W.B. Saunders ;.pp 1533</ref> == | ||
'''Children''' | |||
'''Small VSD''': | '''Small VSD''': | ||
A systolic thrill may be palpable along the left sternal border | * Asymptomatic | ||
* A systolic thrill may be palpable along the left sternal border | |||
* 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''': | '''Medium-Sized VSD''': | ||
* Forceful left ventricular impulse | |||
* Systolic thrill along left sternal border | |||
* Heart sound- split with accentuated pulmonic component , third heart sound (S3)(suggest increased flow across mitral valve) | |||
'''Murmur''' | |||
* Harsh holosystolic murmur at 3rd to 4th intercostal space to left side of sternum (characteristic VSD murmur) | |||
* Rumbling mid-diastolic murmur at cardiac apex suggesting increase flow across the mitral valve. | |||
* Midsystolic ejection murmur due to increased flow across pulmonary valve. | |||
'''Large-Sized VSD with Pulmonary Obstructive Disease''': | '''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 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. | * 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]] | '''Example of VSD murmur:''' [[Media:VSD murmur.mp3]] | ||
Revision as of 15:32, 8 July 2011
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Ventricular septal defect Microchapters | |
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Differentiating Ventricular Septal Defect from other Diseases | |
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Diagnosis | |
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ACC/AHA Guidelines for Surgical and Catheter Intervention Follow-Up | |
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Case Studies | |
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Ventricular septal defect physical examination On the Web | |
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American Roentgen Ray Society Images of Ventricular septal defect physical examination | |
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Risk calculators and risk factors for Ventricular septal defect physical examination | |
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]
Children
Small VSD:
- Asymptomatic
- A systolic thrill may be palpable along the left sternal border
- 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:
- Forceful left ventricular impulse
- Systolic thrill along left sternal border
- Heart sound- split with accentuated pulmonic component , third heart sound (S3)(suggest increased flow across mitral valve)
Murmur
- Harsh holosystolic murmur at 3rd to 4th intercostal space to left side of sternum (characteristic VSD murmur)
- Rumbling mid-diastolic murmur at cardiac apex suggesting increase flow across the mitral valve.
- Midsystolic ejection murmur due to increased flow across pulmonary valve.
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