Auscultation in VSD

Q: A loud holosystolic murmur in the Ventricular Septal Defect (VSD) is a relatively favorable sign?

A) True

B) False

Answer: A

VSDs cause a holosystolic murmur if the pressure in the right ventricle is lower than the left ventricle throughout systole—a continuous left-to-right shunt. This signifies that the VSD is probably small, and pulmonary artery pressure and pulmonary vascular resistance are still in the normal range. Hence, a loud holosystolic murmur in a patient with a VSD signifies a favorable sign in the sense that there are relatively normal right-sided pressures.

VSD murmur is usually accompanied by a thrill. 

The character and timing of the systolic murmur change with large VSDs due to increased right ventricular and pulmonary artery pressure and elevated pulmonary vascular resistance. Instead of being holosystolic, it becomes early systolic, and the peak of the murmur occurs earlier.

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References: 

1. CRAIGE E. Phonocardiography in interventricular septal defects. Am Heart J 1960; 60:51.

2. HOLLMAN A, MORGAN JJ, GOODWIN JF, FIELDS H. Auscultatory and phonocardiographic findings in ventricular septal defect. A study of 93 surgically treated patients. Circulation 1963; 28:94.