Partial Patients with small shunts can be asymptomatic, with only a heart murmur detected on physical examination. In patients with larger shunts, as pulmonary vascular resistance decreases after birth, patients may present with severe manifestations such as profuse sweating, shortness of breath, feeding difficulties, recurrent upper respiratory tract infections, growth retardation, limited activity level, and congestive heart failure. Complete Patients with complete endocardial cushion defects have typical symptoms of congestive heart failure early in life, including recurrent upper respiratory tract infections, feeding difficulties, lack of weight gain, and sweating during feeding. Physical examination reveals tachycardia, dyspnea, hepatomegaly, and increased precordial pulsations. A loud systolic murmur is heard if atrioventricular regurgitation is evident. Chest radiograph shows biventricular macrosomia and pulmonary congestion. The electrocardiogram shows biventricular hypertrophy, prolonged P-R interval, and left-sided electrical axis.