# Ventricular septal defect - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD55.01 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Ventricular Septal Defect - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470330/ - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Ventricular septal defect - disease-level clinical article (ventricular-septal-defect-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text VENTRICULAR SEPTAL DEFECT Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD55.01 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Ventricular Septal Defect - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470330/ Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Ventricular septal defect - disease-level clinical article (ventricular-septal-defect-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - A small defect is usually silent and found by chance on a routine exam - A medium-sized defect tends to become symptomatic later in childhood with mild heart failure - A large defect causes heart failure early in childhood - Eisenmenger syndrome brings cyanosis, breathlessness, fainting, and finger clubbing [breathlessness · cyanosis · finger clubbing · syncope] - Red flag: it can also be acquired, as a rupture of the septum, after severe ischaemic or inflammatory disease [ischaemia] - It is the commonest heart malformation in children, and in adults second only to a bicuspid aortic valve - Red flag: many close by themselves, but a large one that stays open brings lung artery hypertension, Eisenmenger syndrome, failing ventricles and arrhythmia [arrhythmia · hypertension] SIGNS - what you find (6) - A pansystolic murmur heard best at the lower left sternal border [heart murmur] - A small defect gives a harsh, loud murmur, while a large one gives a softer murmur [heart murmur] - Handgrip exercise, which raises afterload, makes the murmur louder [heart murmur] - A decrescendo diastolic murmur with a wide pulse pressure suggests coexisting aortic regurgitation [heart murmur] - In Eisenmenger syndrome the usual VSD murmur can disappear while the pulmonic component of the second heart sound grows louder [heart murmur] - Rarely the hole runs from the left ventricle into the right atrium instead of into the right ventricle TESTS (5) - Color Doppler echocardiography detects up to 95 percent of defects - The ECG is normal in about half of patients with a VSD - Chest x-ray looks normal with a small defect but shows an enlarged heart with a larger one - Cardiac MRI or CT are used when the anatomy is complex or poorly seen on standard echocardiography - Catheterization measures how much resistance the lung vessels offer and how that responds to vasodilator drugs, useful before surgery is planned IF NOT THIS - what else fits (7) - Atrioventricular septal defect is on the differential - Atrial septal defect is another structural mimic - A patent ductus arteriosus can present similarly - Tetralogy of Fallot is included in the differential - Progression to Eisenmenger syndrome is itself listed among the differentials - Infective endocarditis should be considered - Myocarditis is also on the differential list Source StatPearls "Ventricular Septal Defect" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Ventricular septal defect ranges from small defects that close spontaneously to large defects causing heart failure in infancy; the GP recognises the murmur or failure-to- thrive picture and refers to paediatric cardiology, which directs any heart-failure medication and the surgical decision. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Ventricular septal defect ranges from small defects that close spontaneously to large defects causing heart failure in infancy; the GP recognises the murmur or failure-to- thrive picture and refers to paediatric cardiology, which directs any heart-failure medication and the surgical decision. Caution Poor feeding, sweating with feeds, fast breathing, or failure to thrive in an infant with a murmur suggests a large defect needing urgent referral. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Irreversible pulmonary arterial hypertension (Eisenmenger syndrome) is a primary contraindication for surgical VSD closure. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)