Child with a murmur Flashcards
how common are murmurs in paeds?
30-70% will have one. Only 0.8 % will be congenital heart disease. Most are innocent - not assoc with pathology.
examples of lesions causing left to right shunts?
ASD, VSD, PDA
examples of obstructive lesions/cv defects?
coarctation of the aorta, PS, AS
examples of Cyanotic lesions/cv defects?
tetralogy of fallot, transposition of the great arteries
characteristics of innocent murmurs? (5)
- no assoc clicks or thrills
- normal heart sounds (no splitting s2)
- vary with position and respiration
- never limited to diastole (diastolic murmurs are very concerning!!!!)
- early/ejection systolic in nature
what is the most common innocent murmur? characteristics
Still’s murmur.
- 2-6yrs of age
- low to medium pitch
- early to mid systolic
- crescendo descrescendo
- LLSE (left lower sternal edge, tricuspid area)
describe a pulmonary flow murmur?
innocent murmur
- typically children to adolescents
- ejection to mid systolic peak
- 2nd to 3rd interspace LUSE
- beware Ddx: ASD - careful assessment of splitting of S2; pulmonary valve stenosis - ejection click, longer duration, higher pitch, often associated thrill.
describe branched pulmonary stenosis murmur?
innocent murmur
- infants typically less than 6mo
- turbulence due to relative short proximal branch of pulmonary artery compared to bifurcation.
- murmur as per pulmonary flow
- radiates to axilla and back (lung fields)
describe venous hum murmur?
- low pitch continuous murmur occurring in systole and diastole
- most audible lower anterior neck, often infraclavicular area R>L,
- quieter when head turned away or jugular vein compressed
- turbulence at innominate vein: SVC
do innocent murmurs tend to increase or decrease with inspiration?
increase with inspiration. intraothoracic pressure becomes more negative, increasing venous return to right heart
how should postural change affect an innocent murmur?
- increase with squatting
- dissapear when erect
- audible when supine
