Question

CJ is a 16-year-old high school student who is in the clinic for a sports physical prior to beginning basketball practice. He has no known significant medical history, takes no medications, and has no allergies. Subjective data reveal only that CJ is short of breath earlier than most boys on the team. He attributes this to needing to get into better physical condition. The physical is unremarkable except for a grade III systolic murmur heard over the entire precordium. An echocardiogram and cardiac catheterization reveal a ventricular septal defect (VSD) with moderate pulmonary hypertension.

Discussion Questions:

1. A VSD is usually an acyanotic defect. Why is this?
2. What is the mechanism of pulmonary hypertension? What may result if it is prolonged?
3. What other disorders besides VSD can produce a systolic murmur? How can character of the murmur and pattern of radiation be used to differentiate among the etiologic factors?
4. Is it necessary to close a VSD? What are the common complications of untreated VSD?

Answer 1

Q1

VSD is an abnormal opening between the right and left ventricles .With a left-right shunt an increased pulmonary perfusion to the detriment of the systolic circulation is the result..Shunts from the oxygen rich side to a oxygen poor sdes are not usually accompaned by a cyanosis

Q 2 In a heart with medium or large VSD,the heart needs to work harder tp pumb enough blood to the body

INCREASED BLOOD FLOW TO THE LUNGS due to the VSD causes high blood pressure in the lung arteries (pulmonary hypertension) which can permanently damage them this complication can cause reversal of blood flow through the hole

Q3

other disorders beside VSD cause murmurs

Aortic stenosis

pulmonary stenosis

atrial septal defect

mitral regurgitation

tricuspid regurgitation  

EARLY SYSTOLIC MURMURS

-Begin with first sound and peak in the first third of systolic  

-common causes are small VSD

Loud second heart sound ,third heat sound related to the right ventricle ,pansystolic murmer(tricuspid regurgitation) and diastolic murmer  (pulmonary regurgitation) are used to occur due to pulmonary hypertension

IF the defect is small no treatment may be needed .babies with a large VSD who have symptoms related to heart failure may need medicine to control the symptoms and surgery to close the hole

COMPLICATIONS

Aortic insufficiency

damage to the electrical conduction system of the heart during surgery -causing an irregular or slow heart rhythm

delayed growth and development

heart failure