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Ventricular septal defect — MRCPCH FOP MCQ

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ModerateCardiologyVentricular septal defectMRCPCH FOP

A 7-week-old boy has poor feeding, sweating with feeds and tachypnoea. He has a loud pansystolic murmur at the left lower sternal edge, hepatomegaly and normal femoral pulses. What is the most likely diagnosis?

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Correct answer: D — Ventricular septal defect with heart failure

A pansystolic murmur with symptoms of pulmonary overcirculation after the pulmonary vascular resistance falls is typical of a significant ventricular septal defect. Coarctation would be suggested by weak femoral pulses and upper-limb hypertension. An innocent murmur would not cause sweating, tachypnoea or hepatomegaly. The pearl is that feeding history is often the paediatric equivalent of exertional symptoms.

Reference: NICE CKS Heart murmurs in children; RCPCH Progress syllabus