| Ventricular septal defect | 20 to 25 | Small defects: usually asymptomatic | Small defects: loud holosystolic murmur at LLSB (may not last throughout systole if defect is very small) |
| Medium or large defects: CHF, symptoms of bronchial obstruction, frequent respiratory infections |
| Medium and large defects: increased right-to-left ventricular impulses; thrill at LLSB; split or loud single S2; holosystolic murmur at LLSB without radiation; grade 2 to 5; may also hear a grade 1 or 2 mid-diastolic rumble |
| Atrial septal defect | 8 to 13 | Usually asymptomatic and incidentally found on physical examination or echocardiography; large defects can be present in infants with CHF | Grade 2 or 3 systolic ejection murmur best heard at ULSB; wide split fixed S2; absent thrill; may have a grade 1 or 2 diastolic flow rumble at LLSB |
| Patent ductus arteriosus | 6 to 11 | May be asymptomatic; can cause easy fatigue, CHF, and respiratory symptoms | Continuous murmur (grade 1 to 5) in ULSB (crescendo in systole and decrescendo into diastole); normal S1; S2 may be “buried” in the murmur; thrill or hyperdynamic left ventricular impulse may be present |
| Tetralogy of Fallot | 10 | Onset depends on severity of pulmonary stenosis; cyanosis may appear in infancy (2 to 6 months of age) or in childhood; other symptoms include hypercyanotic spells or decreased exercise tolerance | Central cyanosis; clubbing of nail beds; grade 3 or 4 long systolic ejection murmur heard at ULSB; may have holosystolic murmur at LLSB; systolic thrill at ULSB; normal to slightly increased S1; single S2 |
| Pulmonary stenosis | 7.5 to 9 | Usually asymptomatic but may have symptoms secondary to pulmonary congestion | Systolic ejection murmur (grade 2 to 5); heard best at ULSB radiating to infraclavicular regions, axillae, and back; normal or loud S1; variable S2; systolic ejection click may be heard at left sternal border and may vary with respiration |
| Coarctation of the aorta | 5.1 to 8.1 | Newborns and infants may present with CHF; older children are usually asymptomatic or may have leg pain or weakness | Systolic ejection murmur best heard over interscapular region; normal S1 and S2; decreased or delayed femoral pulse; may have increased left ventricular impulse |
| Aortic stenosis | 5 to 6 | Usually asymptomatic; symptoms may include dyspnea, easy fatigue, chest pain, or syncope; newborns and infants may present with CHF | Systolic ejection murmur (grade 2 to 5) best heard at upper right sternal border with radiation to carotid arteries; left ventricular heave; thrill at ULSB or suprasternal notch |
| Transposition of the great arteries | 5 | Variable presentation depending on type; may include cyanosis or CHF in first week of life | Cyanosis; clubbing of nail beds; single S2; murmur may be absent or grade 1 or 2 nonspecific systolic ejection murmur; may have a grade 3 or 4 holosystolic murmur at LLSB and mid-diastolic murmur at apex |
| Total anomalous pulmonary venous connection | 2 to 3 | Onset of CHF at 4 to 6 weeks of age | Grade 2 or 3 systolic ejection murmur at ULSB; grade 1 or 2 mid-diastolic flow rumble at LLSB; wide split fixed S2 |
| Tricuspid atresia | 1.4 | Early-onset cyanosis or CHF within the first month of life | Cyanosis; clubbing of nail beds; normal pulses; single S2; holosystolic murmur at LLSB or midsternal border; murmur may be absent; mid-diastolic flow murmur at apex may be present |
| Hypoplastic left heart syndrome | Rare | May be asymptomatic at birth, with cyanosis and CHF developing with duct closure | Hyperdynamic precordium; single S2; nonspecific grade 1 or 2 systolic ejection murmur along left sternal border |
| Truncus arteriosus | Rare | Onset of CHF in first few weeks of life; minimal cyanosis | Increased cardiac impulses; holosystolic murmur (ventricular septal defect); mid-diastolic rumble |
