What assessment findings are associated with an infant diagnosed with a ventricular septal defect? Select all that apply.

Choice A rationale A large ventricular septal defect (VSD) causes a left-to-right shunt of blood, leading to increased pulmonary blood flow, pressure, and fluid overload in the lungs. This congestion triggers a compensatory mechanism of increased respiratory rate, known as tachypnea, as the body attempts to improve gas exchange and manage the pulmonary edema. Choice B rationale The excessive workload placed on the heart to manage the increased volume of blood shunting to the lungs results in significantly higher energy (caloric) expenditure. This chronic energy drain, coupled with the potential for poor feeding related to respiratory effort, contributes to minimal weight gain and failure to thrive. Choice C rationale Increased pulmonary blood flow and subsequent pulmonary congestion compromise the efficiency of gas exchange and place an excessive burden on the myocardium, leading to cardiac compromise. This results in infants becoming easily exhausted or tiring quickly with any physical effort, which is often observed during feeding attempts. Choice D rationale Poor feeding is a very common symptom in infants with a hemodynamically significant VSD. The infant's rapid breathing (tachypnea) and exhaustion (tiring with activity) make it difficult to sustain the effort required for a full feeding, leading to frequent interruptions, incomplete meals, and inadequate caloric intake. Choice E rationale A ventricular septal defect causes turbulent blood flow as blood is forced through the abnormal opening between the left and right ventricles. This turbulent flow is directly responsible for producing a characteristic harsh, holosystolic murmur, which is typically heard best at the left sternal border and is a key diagnostic finding. Choice F rationale Wheezing is primarily associated with conditions involving airway constriction or lower airway inflammation, such as asthma or bronchiolitis. While severe pulmonary congestion from a large VSD can sometimes mimic wheezing due to compression of small airways, it is not a primary or characteristic assessment finding for an isolated VSD.