schepI picked VSD because of the description of the murmur-loud, harsh, holosystolic, radiates over precordium and palpable thrill at left sternal border (I think because high pressure blood is moving from LV-->RV so you can feel a thrill)
MVP is late systolic, crescendo murmur with midsystolic click+1
castlblack
rule out all diastolic murmurs including -aortic regurg, -mitral stenosis, -PDA (no sound in diastole so cant be continuous).
Rule out all murmurs that are heard on A and M sites, -aortic stenosis, -mitral regurg. Coarctation of the aorta is heard between the scapula I read so rule that out too.
Rule out crescendo decrescendo murmurs, because holosystolic murmurs are like they sound: the same throughout systole. -pulmonic stenosis, -atrial septal defect. (AS has already been ruled out)
You are now left with tricuspid regurg and VSD. Use harsh, high pitched descriptors to pick VSD. Tricuspid is described as blowing just like mitral regurg.
Tricuspid regurg is a close candidate because it is heard in the same place as VSD, can be due to congenital malformation e.g. ebstein anomaly. It is also seen in rheumatic fever and endocarditis, but no other symptoms are mentioned so this question is leaning toward congenital malformation. +
submitted by โathenathefirst(7)
Why is this VSD? Is it just because she is 3 years old? I was stuck between MVP, VSD.