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Acute ventricular septal defect

Aetiology

Myocardial infarcton

Pathophysiology

• left to right shunt
• right ventricular volume overload
  • further complicated by RV infarction
• shunt increased by increased systemic vascular resistance
• shunt decreased by increased pulmonary vascular resistance or left ventricular systolic failure

Clinical features

• deterioration following myocardial infarction
• increasing dyspnoea
• ± chest pain
• ± cardiogenic shock
• pansystolic murmur
  • loudest at left sternal edge
  • ± thrill

Investigations

• ECG: anterior or inferior MI
• CXR
  • cardiomegaly
  • inceased pulmonary interstitial fluid
  • pleural effusions
• echo

Differential diagnosis

• acute mitral regurgitation due to papillary muscle infarction and rupture
  • murmur loudest at apex, often has diastolic component, rarely has palpable thrill

Treatment

Early surgical intervention before deterioration to multiorgan failure

Further reading

Murday A. Optimal management of acute ventricular septal rupture. Heart 2003; 89:1462-6

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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