A ventricular septal defect is a hole in the wall between the ventricles and the most common congenital heart defect. Small defects often close on their own, while large ones shunt blood to the lungs and cause heart failure in the first months of life.
Key symptoms
- Small defect: no symptoms, found by a loud murmur
- Large defect: fast breathing and sweating during feeds
- Poor feeding and slow weight gain
- Frequent chest infections
What you find on exam
- Harsh holosystolic murmur at the left lower sternal border, sometimes with a thrill
- Small defects often have the loudest murmur
- Fast breathing and enlarged liver in heart failure
- Growth plotted on a growth chart
Tests
- Echocardiogram: size and location of the defect
- Chest X-ray: large heart and increased lung markings in large defects
- ECG: left or biventricular hypertrophy
Treatment basics
- Small defect: watch and follow; many close on their own
- Large defect: furosemide and high-calorie feeds
- Surgical or device closure for heart failure, poor growth or rising pulmonary pressure
- Good dental care; antibiotic prophylaxis only in selected repaired cases
Red flags
- Poor feeding with sweating and failure to gain weight
- Fast breathing with an enlarged liver
- New cyanosis in an older child or adult (Eisenmenger syndrome)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NCSBN 2026 NCLEX-RN Test Plan. Written by Making Synapses. Making Synapses is not affiliated with these organizations.