From the Guidelines
Yes, a ventricular septal defect (VSD) typically causes a holosystolic murmur. This murmur occurs throughout systole (the heart's contraction phase) because blood flows continuously from the higher-pressure left ventricle to the lower-pressure right ventricle through the defect during the entire systolic period, as described in the guidelines for the management of patients with valvular heart disease 1. The murmur is usually harsh in quality and best heard at the left lower sternal border.
The characteristics of the murmur can vary depending on the size of the defect and the presence of pulmonary hypertension. For example, smaller VSDs with high pressure gradients may produce louder murmurs than larger defects with equalized pressures, as noted in the guidelines for the management of adults with congenital heart disease 1. The murmur may be accompanied by a palpable thrill (vibration) in the same area.
In some cases, the clinical presentation of a VSD can be influenced by the presence of associated lesions or complications, such as pulmonary hypertension, endocarditis, or arrhythmias, as discussed in the guidelines for the management of grown-up congenital heart disease 1. However, the presence of a holosystolic murmur is a key diagnostic feature of a VSD, and its characteristics can provide important clues about the size and severity of the defect.
Some key points to consider when evaluating a patient with a suspected VSD include:
- The intensity of the murmur generally correlates with the pressure gradient across the defect rather than its size
- Smaller VSDs with high pressure gradients may produce louder murmurs than larger defects with equalized pressures
- The murmur may be accompanied by a palpable thrill (vibration) in the same area
- In infants with large VSDs, the murmur might initially be softer until pulmonary vascular resistance drops after birth
- As the defect size or pulmonary hypertension increases, the murmur may become shorter or disappear entirely due to equalization of pressures between the ventricles, which is an ominous sign requiring prompt medical attention, as noted in the guidelines for the management of adults with congenital heart disease 1.
From the Research
Ventricular Septal Defect and Holosystolic Murmur
- A ventricular septal defect (VSD) is a common congenital cardiac malformation that can exist in isolation or as part of other cardiac anomalies 2.
- The clinical manifestation of VSD depends on the size of the defect and the relationship between systemic and pulmonary vascular resistances 2.
- VSDs can be classified into different types, including perimembranous, muscular, outlet, and inlet VSDs, based on the parts of the ventricular septum involved 3.
- Echocardiography is a crucial tool for diagnosing and characterizing VSDs, providing accurate anatomic and hemodynamic evaluation 3.
- A study found that expert examination can diagnose VSD reliably without an echocardiogram, but errors can occur even when the examiner is confident, especially in distinguishing between minor and major VSDs 4.
- Two-dimensional echocardiography can identify and classify VSDs with varying degrees of accuracy, depending on the location and type of defect 5.
- Holosystolic murmur is a common finding in patients with VSD, but the provided studies do not directly address the relationship between VSD and holosystolic murmur.
- However, it is known that VSDs can cause abnormal blood flow between the ventricles, leading to murmurs, including holosystolic murmurs 6.