A 10-year-old boy is brought to the physician by his father, who is concerned because his son has been less interested in playing soccer with him recently. They used to play every weekend, but his son has started to tire easily and has complained of pain in the lower legs while running around on the soccer field. The boy has no personal or family history of serious illness. Physical examination shows a well-appearing child. The lungs are clear to auscultation. Cardiac auscultation findings at the left lower sternal border are given below. The auscultatory abnormality intensifies with the handgrip exercise. Which of the following is the most likely diagnosis?

Question

A 10-year-old boy is brought to the physician by his father, who is concerned because his son has been less interested in playing soccer with him recently. They used to play every weekend, but his son has started to tire easily and has complained of pain in the lower legs while running around on the soccer field. The boy has no personal or family history of serious illness. Physical examination shows a well-appearing child.  The lungs are clear to auscultation.  Cardiac auscultation findings at the left lower sternal border are given below.  The auscultatory abnormality intensifies with the handgrip exercise.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: A ventricular septal defect (VSD) commonly causes a harsh, holosystolic murmur at the left lower sternal border; the murmur increases in intensity during maneuvers that increase left ventricular afterload (eg, handgrip maneuver).  A small VSD is usually asymptomatic and produces a relatively loud murmur due to a high interventricular pressure gradient.

A 10-Year-Old Boy Is Brought to the Physician by His