Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

Ventricular Premature Complexes Ventricular Septal Defect (VSD) 1527

follow-up

■Treatment of underlying diseases

complications and prognosis

■Marker of sudden death in patients with infarction, especially in the

presence of LV dysfunction.

VENTRICULAR SEPTAL DEFECT (VSD)

MARIA ANSARI, MD

history & physical

History

■Rarely presents in adulthood unless small and hemodynamically

insignificant or large and associated with Eisenmenger’s physiology

■Associated with Down’s syndrome and Holt-Oram syndrome

■50% of cases associated with other cardiac anomalies such as tetral-

ogy of Fallot, PDA, AI, TR or infindibular stenosis

Signs & Symptoms

■Symptoms usually do not develop until shunt ratio greater than 2:1

■Patients with Eisenmenger’s will have dyspnea and cyanosis

■Holosystolic murmur at lower left sternal border

■Thrill at 4th ICS

■Enlarged LV and RV

tests

Screening

■Physical exam

Imaging

■CXR may show cardiomegaly and pulmonary venous congestion

■EKG may demonstrate biventricular hypertrophy

■Echocardiogram is diagnostic and defines location, size and physi-

ology with 80% located in membranous septum

■Catheterization usually unnecessary unless there is a discrepancy

between non-invasive and clinical data

differential diagnosis

■Physical exam murmur may be mimicked by mitral regurgitation or

PDA