Physical examination in children with complete AV septal defects shows an active precordium due to volume and pressure overload of the right ventricle; a single, loud second heart sound (S2) due to pulmonary hypertension; a grade 2 to 3/6 systolic murmur due to increased flow across the pulmonary outflow tract; and sometimes a diastolic murmur at the apex and low left sternal border related to increased flow across the AV valves (see table).