Factors Controlling Loudness of VSD Murmurs

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1. What is the relationship between the size of the VSD and the loudness of the murmur?

ANS: If it is very small (pinhole VSD), the murmur may be very soft. If it is very large, so that there are almost equal pressures in the RV and the LV, the murmur may also be very soft. If, however, it is moderately large, there is usually a very loud murmur. (Some of the loudest murmurs observed in cardiological practice, next to prolapsed valve honks, are caused by moderately large VSDs.)

2. What auscultatory clues indicate that a soft VSD murmur is due to a large VSD with severe pulmonary hypertension?

ANS: a. The murmur is often preceded by an ejection sound when the pulmonary artery is dilated. b. If a large flow is still present (the pulmonary hypertension is then said to be hyperkinetic, vasoactive, or vasospastic), a mitral diastolic murmur due to excess flow through the mitral valve may be heard.

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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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