Neonatal Nurse Practitioner Practice Exam

What congenital heart defect may be suspected if a systolic murmur is noted in a neonate?

1. Atrial septal defect

2. Pulmonary valve stenosis

3. Ventricular septal defect

4. Coarctation of the aorta

The correct answer is: Ventricular septal defect

In the context of congenital heart defects in neonates, the presence of a systolic murmur can indicate different underlying conditions, but ventricular septal defect (VSD) is a commonly suspected diagnosis. VSD is characterized by an abnormal opening between the left and right ventricles of the heart, allowing blood to flow from the higher-pressure left ventricle to the lower-pressure right ventricle during systole. This shunting of blood can create a turbulent flow, which is heard as a systolic murmur during auscultation. The systolic murmur associated with VSD is typically described as a harsh, holosystolic (or pansystolic) sound best heard at the left lower sternal border. Due to the relatively high prevalence of VSD compared to other congenital defects, and the specific characteristics of the murmur, it is a strong candidate when a systolic murmur is detected. While other congenital heart defects, such as atrial septal defect, pulmonary valve stenosis, and coarctation of the aorta, may also produce murmurs, the specific presentation of a systolic murmur aligns more classically with VSD, particularly in neonates. Each of these other conditions can present with murmurs