Ventricular Septal Defect

Question 1

What are your differential diagnoses for a pan systotic murmor?

Answer 1

o MR – PSM at apex radiates towards the axilla, soft S1

o TR – PSM heard at the triscupid area, louder on inspiration; usually secondary to pulmonary hypertension or seen in IVDAs; Giant V wave, pulsatile liver

o VSD – PSM heard at the LLSE which is louder on expiration, radiates to RSE

Question 2

What are the causes of a VSD?

Answer 2

o Congenital
 o Acquired (MI)

Question 3

What are the complications of VSD?

Answer 3

o AR
o Pulmonary Hypt
o Eisenmenger’s Syndrome
o CCF
o IE

Question 4

Differentiate a VSD from tetralogy of fallot and HCOM murmor.

Answer 4

Fallot’s tetralog:
o Pulmonary thrill, PS murmur
o Clubbed and central cyanosis (but could be VSD with Eisenmenger’s)

HOCM
o ESM rather than PSM
o Apex is not displaced, double apical impulse
o Jerky pulse

Question 5

How common is a VSD?

Answer 5

o The most common congenital heart condition
o 2 per 1000
o Usually in the membranous portion (can also be found in the muscular)
o Small defects close spontaneously in early childhood in about 50%