A 29-day old child presents with features of congestive cardiac failure and left ventricular hyperophy. Auscultation shows a sho systolic murmur. Most likely diagnosis is -

Ans. is 'd' i.e., i.e., VSD o The answer is quite obvious. o TOF and TGA are cyanotic hea diseases and o Rheumatic fever can be ruled out on basis of age. (Age group of rheumatic fever is 5-15 yrs.) Clinical manifestation of VSD o The patients become symptomatic around 6 to 10 weeks of age. o At this time CHF may develop. o Frequent symptoms Palpitation, dysnea on exeion and chest infections. Signs o Hyperkinetic precordium with a thrill at the left sternal border. o Pansystolic murmur at left sternal border. SI & S2 are masked by pansystolic murmur maximum intensity of murmur is at 3rd,4th or 5th left interspace. o S2 can be make out at pulmonary area (upper left sternal border) where it is not masked by pansystolic murmur -S2 is widely split with accentuation of P2. S, may be audible at apex. o A delayed diastolic murmur in mitral area. Pulmonary systolic ejection murmur in pulmonary area.