An young man previously diagnoses as a case of congenita! hea disease-left to right shunt has a very loud pansystolic murmur at the left sternal edge without any hemodynamic distrubance. He is likely to be having-
ventricular septal defect (VSD) is a defect in the ventricular septum, the wall dividing the left and right ventricles of the hea. The extent of the opening may vary from pin size to complete absence of the ventricular septum, creating one common ventricle. The ventricular septum consists of an inferior muscular and superior membranous poion and is extensively innervated with conducting cardiomyocytes signs and symptoms Ventricular septal defect is usually symptomless at bih. It usually manifests a few weeks after bih. VSD is an acyanotic congenital hea defect, aka a left-to-right shunt, so there are no signs of cyanosis in the early stage. However, uncorrected VSD can increase pulmonary resistance leading to the reversal of the shunt and corresponding cyanosis. Pansystolic (Holosystolic) murmur along lower left sternal border (depending upon the size of the defect) +/- palpable thrill (palpable turbulence of blood flow). Hea sounds are normal. Larger VSDs may cause a parasternal heave, a displaced apex beat (the palpable heabeat moves laterally over time, as the hea enlarges). An infant with a large VSD will fail to thrive and become sweaty and tachypnoeic (breathe faster) with feeds. The restrictive ventricular septal defects (smaller defects) are associated with a louder murmur and more palpable thrill (grade IV murmur). Larger defects may eventually be associated with pulmonary hypeension due to the increased blood flow. Over time this may lead to an Eisenmenger's syndrome the original VSD operating with a left-to-right shunt, now becomes a right-to-left shunt because of the increased pressures in the pulmonary vascular bed ref Harrison20th edition pg 1299
Atrial septal defect
Large ventricular septal defect
Small ventricular septal defect
Eisenmenger's syndrome
C.V.S