pediatrics
Ventricular Septal Defect (VSD)
Symptoms and Signs of VSD
Symptoms depend on defect size and magnitude of the left-to-right shunt. Children with a small ventricular septal defect are typically asymptomatic and grow and develop normally. In children with a larger defect, symptoms of Heart failure (eg, respiratory distress, poor weight gain, fatigue after feeding) appear at age 4 to 6 weeks when pulmonary vascular resistance falls. Frequent lower respiratory tract infections may occur. Eventually, over years, untreated patients may develop symptoms of Eisenmenger syndrome. Auscultatory findings vary with the size of the defect. Small VSDs typically produce murmurs ranging from a grade 1 to 2/6 high-pitched, short systolic murmur (due to tiny defects that actually close during late systole) to a grade 3 to 4/6 holosystolic murmur (with or without thrill) at the lower left sternal border; this murmur is usually audible within the first few days of life (see table). The precordium is not hyperactive, and the second heart sound (S2) is normally split and has normal intensity. Moderate VSDs produce a holosystolic murmur that is present by age 2 to 3 weeks; S2 is usually narrowly split with an accentuated pulmonary component. An apical diastolic rumble (due to increased flow through the mitral valve) and findings of heart failure (eg, tachypnea, dyspnea with feeding, failure to thrive, gallop, crackles, hepatomegaly) may be present. In moderate, high-flow VSDs, the murmur is often very loud and accompanied by a thrill (grade 4 or 5 murmur). With large defects allowing equalization of left ventricular and right ventricular pressures, the systolic murmur is often attenuated. 