<prompt> A 29day old child presents with features of congestive cardiac failure and left ventricular hypertrophy. Auscultation shows a short systolic murmur. Most likely diagnosis isRheumatic feverTetralogy of FallotTransposition of great arteriesVentricular septal defect  <response>: The answer is quite obvious.TOF and TGA are cyanotic heart diseases andRheumatic fever can be ruled out on basis of age. Age group of rheumatic fever is 5-15 yrsClinical manifestation of VSD The patients become symptomatic around 6 to 10 weeks of age.At this time CHF may develop.Frequent symptoms Palpitation, dysnea on exertion and chest infections.SignsHyperkinetic precordium with a thrill at the left sternal border.Pansystolic murmur at left sternal border.S1 S2 are masked by pan-systolic murmur maximum intensity of murmur is at 3rd, 4th or 5th left interspace.S2 can be make out at the pulmonary area upper left sternal border where it is not masked by pan-systolic murmur S2 is widely split with accentuation of P2S3 may be audible at the apex.A delayed diastolic murmur in mitral area.Pulmonary systolic ejection murmur in pulmonary area. 