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Ventricular Septal Defects

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Topic updated on 07/31/16 7:17am

Snap Shot
  • 3-year-old boy is brought to your office by his parents, because he gets tired very easily and cannot keep up with the other children. On exam, you hear a loud, pansystolic murmur at the left lower sternal border without radiation to the axillae.
Introduction
  • Most common congenital heart defect
  • Observed in
    • Tetralogy of Fallot
    • Down's syndrome
    • cri-du-chat syndrome
    • trisomy 13/18
  • Most small, asymptomatic lesions will close spontaneously
  • Larger defects require surgery or may lead to Eisenmenger's syndrome
Presentation
  • Symptoms
    • small defects
      • typically asymptomatic
      • symptoms may appear by 6 months of age
        • range broadly depending on degree of left to right shunt
    • large defects present with
      • CHF symptoms (SOB, pulmonary edema, etc.)
      • decreased development/growth
      • exercise and/or feeding intolerance
      • frequent respiratory infections
  • Physical exam
    • pansystolic-holosystolic, harsh, vibratory, murmur at the left lower sternal border (LLSB)
    • loud, pulmonic S2
    • crackles
    • cardiomegaly in severe cases


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(M1.CV.7) An 8-year-old African-American male is found to have a holosystolic, harsh-sounding murmur upon physical examination. The murmur is best appreciated at the left sternal border, and is found to be louder when the patient squats. Which of the following is the most likely diagnosis?
Topic Review Topic

1. Ventricular septal defect
2. Patent ductus arteriosus
3. Atrial septal defect
4. Tricuspid atresia
5. Aortic stenosis

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