A 2-month-old infant presents with poor feeding, excessive sweating during feeds, and failure to thrive. Examination reveals a harsh pansystolic murmur at the left lower sternal border, with a mid-diastolic rumble at the apex. What is the MOST likely diagnosis?

• A Atrial septal defect
• B Patent ductus arteriosus
• C Pulmonary stenosis
• D Ventricular septal defect ✓

Explanation

A large VSD causes a left-to-right shunt leading to pulmonary overcirculation and congestive heart failure, manifesting as feeding difficulty, diaphoresis, and failure to thrive. The pansystolic murmur is loudest at the left lower sternal border, and the mid-diastolic rumble at the apex reflects increased flow across the mitral valve due to volume overload. Small VSDs close spontaneously; large ones require surgical or transcatheter closure.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.