Ventricular Septal Defect (VSD) and ECG Findings

Introduction

Ventricular Septal Defect (VSD) is one of the most common congenital heart defects. It is a condition in which there is an abnormal opening in the septum between the right and left ventricles of the heart. This allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood in the right ventricle, leading to various hemodynamic changes.

How VSD Affects the Heart

• Small defects may be asymptomatic and close spontaneously.
• Moderate to large defects can lead to excess blood flow to the lungs, increasing the workload on the heart and potentially leading to heart failure if untreated.
• Complications may include pulmonary hypertension, arrhythmias, and endocarditis.

ECG Findings in VSD

Electrocardiography (ECG) is often used as part of the diagnostic workup for VSD. The specific ECG findings depend on the size of the defect and the associated hemodynamic burden:

• Small VSDs: The ECG may be normal.
• Moderate to large VSDs:
  • Signs of left ventricular hypertrophy (LVH) due to volume overload.
  • Evidence of right ventricular hypertrophy (RVH) if there is significant pulmonary hypertension.
  • Possible right axis deviation (RAD).
  • Prolonged PR interval if there is conduction system involvement.
  • Atrial enlargement due to increased atrial volume overload.

Diagnosis and Management

• Echocardiography is the gold standard for diagnosing VSD as it allows visualization of the defect and its hemodynamic effects.
• Medical management includes diuretics and afterload reduction in symptomatic cases.
• Surgical closure or device closure via catheterization is indicated for large or symptomatic defects to prevent complications.

Conclusion

ECG can provide important clues regarding the presence and severity of VSD, but echocardiography remains the definitive diagnostic tool. Early diagnosis and appropriate management are crucial for preventing long-term complications.

Source recommendations

1. 2020 European Society of Cardiology (ESC) Guidelines for the Management of Adult Congenital Heart Disease

1. https://pubmed.ncbi.nlm.nih.gov/32860028/
2. https://academic.oup.com/eurheartj/article/42/6/563/5898606
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Grown-Up-Congenital-Heart-Disease-Management-of
4. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.010
5. https://www.revespcardiol.org/en-2020-esc-guidelines-for-management-articulo-S1885585721001201

2. 2018 American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for the Management of Adults with Congenital Heart Disease

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000603
2. https://pubmed.ncbi.nlm.nih.gov/30121240/
3. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/08/13/16/26/2018-AHA-ACC-Guideline-for-the-Management-of-ACHD
4. https://pubmed.ncbi.nlm.nih.gov/30586767/
5. https://www.jacc.org/guidelines/achd