A 2-month-old infant is rushed to the emergency room. Upon assessment, the nurse notes excessive sweating and fatigue and a loud, harsh holosystolic murmur along the left sternal border at the fourth intercostal space. The nurse suspects that the child must be experiencing what disease condition?


•Ventricular septal defect is the most common congenital heart defect. It is an abnormal opening between the right and left ventricles. It causes a holo systolic murmur (starts with S1 and ends with S2).

•Pressure from the left ventricle causes blood to flow through the defect into the right ventricle, causing pulmonary vascular resistance and right heart enlargement. Right ventricular and pulmonary artery pressures increase, leading to pulmonary vascular disease.

•Incorrect: Aortic stenosis is the narrowing of the aortic valve. This is a crescendo-decrescendo systolic murmur heard best at the second intercostal space, right sternal border.

•Incorrect: Patent ductus arteriosus results when the fetal ductus arteriosus fails to close completely after birth. There is often a machine-like murmur present.

•Incorrect: Coarctation of aorta is a defect that involves a localized narrowing of the aorta. There is generally no murmur associated with this.

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