Ventricular septal defect physical examination

Ventricular septal defect Microchapters
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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

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