Acyanotic Congenital Heart Disease Ventricular Septal Defect

(VSD) and Patent Ductus Arteriosus (PDA)

Lavina Belayutham

Systemic Examination

Cardiovascular System Examination

Inspection• Shape of the chest is normal and is bilaterally

symmetrical.• Trachea appears central.• No visible precordial bulge.• Apex beat is visible at the left 5th intercostal

space, lateral to the midclavicular line.• Suprasternal pulsations seen.• No dilated veins, scars or sinuses.

Palpation• Trachea is confirmed to be central.• Apical impulse confirmed to be in the left 5th

intercostal space, lateral to the midclavicular line.

• Hyperdynamic apex beat• Palpable thrill felt at second left intercostal

space (PDA)• Palpable thrill felt along the left parasternal

region (VSD)• Parasternal heave is present

Percussion

Not performed

AuscultationArea Findings

Aortic S1S2 heard

Pulmonary S1S2 heardGrade IV continuous murmur best heard with the diaphragm of the stethoscope

Mitral S1S2 heard

Tricuspid S1S2 heardHigh pitched, pansystolic murmur of grade IV best heard with the diaphragm of the stethoscope in the left parasternal region especially in the 3rd and 4th intercostal space

Infraclavicular S1S2 heardGrade IV continuous murmur best heard with the diaphragm of the stethoscope

Left second intercostal space S1S2Grade IV continuous murmur best heard with the diaphragm of the stethoscope

Respiratory system examination

Inspection

-Flaring of ala nasi is present

-Trachea appears to be central

-Chest movements are bilaterally symmetrical

-Chest indrawing present

-Subcostal recession present

-No dilated veins, scars, sinuses

Palpation- The inspectory findings are confirmed-Trachea is confirmed to be central-Chest movements are equal on both sides-Chest circumference : 36cm

Percussion-Resonant note heard in all the lung areas-Cardiac dullness present at left 5th intercostal space,

lateral to midclavicular line

Auscultation-Normal vesicular breath sounds heard-No added sound

Per abdomen Examination- Soft, non tender- No organomegaly- No free fluid in the abdomen

Central Nervous System Examination

-No neurological deficit

Per abdomen Examination- Soft, non tender- No organomegaly- No free fluid in the abdomen

Central Nervous System Examination

-No neurological deficit