Ventricular Septal Defect (VSD) is one of the few cardiovascular cases where the patient may be young. It is an congenital cyanotic heart condition due to left to right shunting.

They are normally heard loudest in the lower left sternal edge.

The key aspect is to remember is that the smaller the defect, the louder the murmur. In the PACES, like certain other defects, you will be very unlikely to have a patient in cardiovascular compromise.

If there is compromise and pulmonary hypertension, there may be a right parasternal have representing right ventricular overload with a raised JVP.

Complications include Eisenmenger’s syndrome if VSD’s are untreated. It does also increase the risk of bacterial endocarditis (subacute).

There are four types of VSDs with their own management profiles:

Membranous Septal VSD

  • Most common
  • Sits just behind the medial papillary muscle of the tricuspid
  • Tend to close spontaneously in childhood

Muscular septal VSD

  • Different sites
  • Occurs after myocardial infarction where there is septal infarction
  • Also, if small, can close in childhood sponanteously

Infundibular VSD

  • Occurs just beneath the pulmonary valve
  • Also occurs just below the right coronary cusp of the aortic valve
  • Does not close spontaneously during childhood
  • Occurs in Tetralogy of Fallot

Posterior VSD (aka atrioventricular)

  • This is a para-tricuspid defect