Ventricular septal defect physical examination

Ventricular septal defect Microchapters
Home
Patient Information
Overview
Classification
Pathophysiology
Causes
Differentiating Ventricular Septal Defect from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography
Cardiac Catheterization
Treatment
Medical Therapy
Surgery
Ventricular septal defect post-surgical prognosis
ACC/AHA Guidelines for Surgical and Catheter Intervention Follow-Up
Prevention
ACC/AHA Guidelines for Reproduction
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Ventricular septal defect physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Ventricular septal defect physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Ventricular septal defect physical examination
CDC on Ventricular septal defect physical examination
Ventricular septal defect physical examination in the news
Blogs on Ventricular septal defect physical examination
Directions to Hospitals Treating Ventricular septal defect
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

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.

Adults

Small VSD -

• asymptomatic
• Holosystolic murmur heard best at left sternal border in the 3rd and 4th intercostal space

Moderate VSD

• Displaced cardiac apex
• Harsh holosystolic murmur at 3rd to 4th intercostal space to left side of sternum
• 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 VSD

Example of VSD murmur: Media:VSD murmur.mp3