Cardiac examination for ventricular septal defect

Graphic illustration of the cardiac examination in ventricular septal defect (VSD).
(A) Holosystolic murmur of VSD.
(B) Shortened systolic murmur of muscular VSD.
(C) Typical murmur of VSD with mild pulmonary stenosis (PS) showing the delayed pulmonary closure sound (P₂).
(D) Systolic ejection murmur of severe pulmonary stenosis with delayed and reduced P₂.
(E) Eisenmenger complex with absence of the holosystolic murmur of VSD (see text), a loud P₂ secondary to pulmonary hypertension, and pulmonary regurgitation (PR) diastolic murmur.
(F) VSD murmur followed by diastolic murmur of aortic regurgitation (AR).