BOF: 25
An 18-year-old male has been
referred to the clinic by his GP. He had attended a medical examination when he
applied to join the army and was told he had a hole in his heart. Which of the
following physical signs would have made the examining doctor suspect that the
patient has a ventricular septal defect (VSD)?
a)
Fixed splitting of the second heart sound
b)
A pan systolic murmur best heard at the left sternal edge
c)
A pan systolic murmur best heard at the apex
d)
An early diastolic murmur best heard at the left sternal edge
e)
A mid diastolic murmur best heard at the apex
Answer
b)
Pan systolic murmurs may be
heard in VSD, MR and TR (See ACES for PACES page
211)
Murmurs best heard at the left
sternal edge are VSD, HOCM, AR and TR (See ACES for
PACES page 209)
Thus a pan systolic murmur best
heard at the left sternal edge would make one suspect that the patient has a
VSD.
Fixed splitting of the second
sound is a feature of ASD (See ACES for PACES page
206)
Apical murmurs may originate
from the mitral valve or the aortic valve (See ACES
for PACES page 209)
Early diastolic murmurs may be
due to AR or PR (See ACES for PACES page 211)
Mid diastolic murmurs may be
due to multiple causes (See ACES for PACES page 211)
Remember VSD too can result in
a mid diastolic murmur at the apex due to increased flow across the mitral valve
(See ACES for PACES page 211)
Last Updated: 15/04/06
