Dawaa Reference

chronic

Ventricular septal defect

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 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 against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Ventricular septal defect - disease-level clinical article (ventricular-septal-defect-clinical.txt)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Ventricular Septal Defect" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

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

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose 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.

Cautions
  • 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.