CJ is a 16-year-old high school student who is in the clinic for a sports physical prior to beginning basketball practice. He has no known significant medical history, takes no medications, and has no allergies. Subjective data reveal only that CJ is short of breath earlier than most boys on the team. He attributes this to needing to get into better physical condition. The physical is unremarkable except for a grade III systolic murmur heard over the entire precordium. An echocardiogram and cardiac catheterization reveal a ventricular septal defect (VSD) with moderate pulmonary hypertension. Discussion Questions:
1. A VSD is usually an acyanotic defect. Why is this?
2. What is the mechanism of pulmonary hypertension? What may result if it is prolonged?
3. What other disorders besides VSD can produce a systolic murmur? How can character of the murmur and pattern of radiation be used to differentiate among the etiologic factors?
4. Is it necessary to close a VSD? What are the common complications of untreated VSD?

VSD known as ventricular septal defect is a heart condition that caused by trauma, surgery or a heart attack in adults or it's congenital (present at birth). It is characterised by an abnormal connection or hole between the lower chambers of the heart.

A VSD is usually an acyanotic defect. Why is this?

Ventricular septal defect is usually an acyanotic defect or a non-cyanotic heart defect because in it,the level of oxygen in the body is not affected, in VSD blood is shunted that's is blood flows from the left side of the heart to the right side of the heart.

This is most often as a result of a structural defect, a hole in the intraventricular septum.

What is the mechanism of pulmonary hypertension? What may result if it is prolonged?

When there is undue or excessive stress on the heart especially the heart muscles,the pulmonary arteries also gain high pressure and this high pressure results in an acute injury to the capillary walls of the alveolar and subsequent resulting to edema.

When it is prolonged, it can cause the thickening of the thickening of the walls of the alveolar capillary membrane irreversibly and thereby compromising the function of the lungs.

What other disorders besides VSD can produce a systolic murmur? How can character of the murmur and pattern of radiation be used to differentiate among the etiologic factors?

Other disorders beside VSD that can produce a systolic murmur are;

Pulmonary infundibular stenosis,tetralogy of Fallot, atrial septal defect, valvular pulmonary stenosis,aortic sclerosis, hypertrophic obstructive cardiomyopathy, supravalvular aortic stenosis.

The character of the murmur can be used to differentiate among the etiologic factors by taking into consideration whether the heart murmur is functional/physiologic(primarily due to a physiologic condition outside the heart),murmurs due to structural defect in the heart itself,the functional murmurs which are benign,pathologic murmurs are as a result of a problems within the heart like abnormal passages or leaking of valves, systolic or diastolic murmur is as a result bif the timing of the murmur(the part of the heartbeat they are heard from).

Is it necessary to close a VSD? What are the common complications of untreated VSD?

Small ventricular septal defect may close on their own as they are likely to cause no problem, however, medium or large ventricular septal defect may pose a problem and therefore will require a surgical intervention/repair early enough inorder to prevent complications.

Some of the common complications of ventricular septal defect are;

Heart valve problem,poor growth and development,lung problems, irregular heart rhythms(arrhythmias), heart failure, pulmonary hypertension,lung damage.

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