During a regular check-up of an 8-year-old child, you note a loud first heart sound with a fixed and widely split-second heart sound at the upper left sternal border that does not change with respirations. The patient is otherwise active and healthy. Which of the following heart lesions most likely explains these findings?
Most children with an ASD are asymptomatic; the lesion is found during a routine examination. In older children, exercise intolerance can be noted if the lesion is of significant size. On examination, the pulses are normal, a right ventricular systolic lift at the left sternal border is palpable, and a fixed splitting of the second heart sound is audible. For lesser degrees of ASD, surgical treatment is controversial.VSD commonly presents as a harsh or blowing holosystolic murmur best heard along the left lower sternum, often with radiation throughout the precordium. The auscultatory finding of tricuspid regurgitation is typically a blowing holosystolic murmur, augmented during inspiration, and best heard at the left lower sternal border; a middiastolic rumble may also be heard. A history of birth asphyxia or findings of other cardiac lesions may be present. Tetralogy of Fallot is a common form of congenital heart disease. The four abnormalities include right ventricular outflow obstruction, VSD, dextroposition of the aorta, and right ventricular hypertrophy; the cyanosis presents in infants and in young children. Mitral valve prolapse occurs with the billowing into the atria of one or both mitral valve leaflets at the end of systole. It is a congenital abnormality that frequently manifests only during adolescence or later. It is more common in girls than in boys and seems to be inherited in an autosomal dominant fashion. On clinical examination, an apical murmur is noted late in systole, which can be preceded by a midsystolic click. The diagnosis is confirmed with an echocardiogram that shows prolapse of the mitral leaflets during mid to late systole.
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Isolated tricuspid regurgitation
Tetralogy of Fallot
C.V.S.