Premium
VENTRICULAR SEPTAL DEFECTS: 1. A PRESENTATION PROFILE 1
Author(s) -
Menahem Samuel
Publication year - 1971
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1971.tb92813.x
Subject(s) - medicine , cardiology , precordial examination , presentation (obstetrics) , auscultation , right ventricular hypertrophy , heart murmur , heart sounds , heart failure , pulmonary hypertension , electrocardiography , surgery
A study was undertaken of the 94 new patients with ventricular septal defects seen at the Cardiac Department of the Royal Children's Hospital in 1964. Their clinical features and Investigations, aided by catheter findings in about a third of cases, enabled the classification of the subjects into five groups on the basis of their hæmodynamic disturbance at presentation. The majority of subjects had small defects, initially diagnosed during an intercurrent infection or on routine examination. They were free of symptoms and clinically had the classical loud pansystolic lower precordial murmur. The electrocardiographic and chest X‐ray findings were normal. A second group with small defects had the same clinical features except for only a moderately loud, high‐frequency, early to mid‐systolic murmur related to the site of the defect within the muscular septum. In contrast, subjects with large defects presented early because of development of symptoms—usually dyspnœea and failure to thrive, together with respiratory infection. They exhibited tachypncœa and subcostal retraction with an enlarged, hyperactive heart. The murmur was loud and long, usually with accentuation of pulmonary closure and the presence of a soft apical mid‐diastolic rumble. The electrocardiogram indicated left or combined ventricular hypertrophy and the chest X‐ray film showed an enlarged heart with pulmonary plethira. The three subjects with Elsenmenger's syndrome were cyanosed and had an ejection precordial murmur with a loud, palpable pulmonary second sound. The significance of the clinical findings is discussed in the light of previous work.