5. Paediatric Murmur

Question 1

What factors allow distinguish between innocent and pathological murmur

Innocent

Answer 1

Innocent

Normal Growth & exercise tolerance
Hx asymptomatic typical cardiac symptoms
(SOB / Cyanosis)

O/E
Normal HS
Soft, early / blowing systolic murmur
(pulmonary outflow / heard over L 2nd IS

Short buzzing murmur - usually from left side - 4th IS

Non radiation

Venous HUM

Presence of fever - d/t increased CO

Question 2

Pathological murmur

Answer 2

Evidence congenital heart disease
notes/parents in FH

Hx FTT / poor feeding / reduced exercise tolerance, cyanosis (on crying)

On exam

Abnormal added heart sounds - click

Pansystolic ESM Diastolic loud murmur

Sternal heave

Parasternal thrill

Abnormal peripheral pulses
(weakened fem art pulse)

Question 3

Actions to take when murmur discovered

Answer 3

Options depends local guidelines
Preop ECG

Both AS & HOCM may present as innocent murmur with few sy
ecg cxr echo if more sinister suspected

Hx suspicious / exam / ecg
- refer to paediatric cardiologist

Question 4

Options

Proceed

Answer 4

1
Proceed w/ surgery

?abx according to local guidelines
surgery likely cause bacteraemia - dental
unlikely for grommet

Organise postop invx id document murmur for future cases

Question 5

Options

2 Delay to investigate

Answer 5

Evaluate urgency of op
elective - postpone until invx

Referral to paediatric cardiologist preop
with ecg for expert opinion & echo

Perform CXR if resp sy

Documentation in notes & parent education