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Flashcards in Paediatric cardiology Deck (44):

What is this murmur?



Why might VSD and patent ductus arteriosus only become clinically apparent (murmur + signs) several weeks later post birth?

decreasing pulmonary vascular resistance


What is this murmur?



what is important to advise a parent who has a clinically well child with a VSD and normal ECG?

VSD usually closes spontaneously

regular followup and monitoring of murmur is needed

good dental hygiene is paramount due to increased risk of bacterial endocarditis


what happens if we leave a L-R shunt congenital heart defect untreated?

development of right sided heart failure, also known as eisenmenger syndrome


What is this murmur?



What is this murmur?

pulmonary stenosis


tell me the characteristics of an ASD murmur?

ejection systolic murmur usually heard left sternal edge

fixed widely split 2nd heart sound

sometimes may be pansystolic if partial ASD


what cause of heart failure usually presents in the first week of life?

coarctation of the aorta

(severe obstructive lesion_


what type of murmur is VSD?

pansystolic or no murmur if very large


What is this murmur?

Aortic stenosis and regurgitation


What is this murmur?



what is the most common form of ASD? What is the other form of ASD

Secundum ASD most common- hole between atria in the centre of the atrial septum, involving the foramen ovale


other form of ASD is known as partial AVSD where the hole between the atria as at the BOTTOM of the atrial septum, often involving abnormal atrioventricular leaflets


where exactly is the ductus arteriosus in the fetal heart?

between the pulmonary artery and the aorta


What is this murmur?

bicuspid aortic valve


what are the two types of VSD?

small and large VSD


What is this murmur?

innocent murmur and S3


why might you get pulmonary valve regurgitation post TOF surgery?

often occurs because the surgery shaves off a bit of the hypertrophied valve, and overtime the PV can become incompetent and leak. requires replacement usually


when does the ductus arteriosus normally close in a newborn?

within hours to 1 day


what are some clinical signs of heart failure to look for on cardiovascular examination in an infant?

sacral oedema

central cyanosis and at the end of exam during crying

signs of respiratory distress

enlarged liver

feel for right ventricular hypertrophy

listen for any pathological murmurs, loud s2

is the baby clammy?

palpate brachial artery and assess volume

failure to thrive



what are some clinical features of heart failure in a young to older child on CV examination?

SOBOE- so assess exercise tolerance

Assess growth using centiles

look for peripheral oedema/periorbital oedema

look for signs of cyanosis

is the child squatting?- may indicate TOF


what is the most common type of innocent murmur?

still's vibratory murmur

typically heard between 2-6 years age

early to mid systolic

loudest at left lower sternal edge


      what are the ddx for pulmonary flow innocent mumur?


Pulmonary stenosis


what murmur is typically seen ONLY in an infant?

branch pulmonary stenosis



tell me about a venous hum

innocent murmur

low pitch continuous murmur

caused by turbulence in the SVC junction


what manouevers could we do to see whether a murmur is innocent?

Innocent murmur dynamics usually involve:

variation with respiration--> increase with inspiration

variation with posture--> audible when lying down and disappears with standing up


so get the child to breathe in and out while listening, and repeat auscultation with the child standing up


when should you be worried about a murmur enough to refer to a cardiologist 

Pansystolic murmur

added sounds

subjective intensity greater than 3

Upper sternal border location

child less than 1 yrs + symptomatic/clinical judgement


most common cause of cyanosis AT BIRTH?

transposition of the great arteries


what cardiac structural change is associated with large VSD?

volume loading of the LEFT HEART--> left ventricle dilation


why would ace inhibitors be of any use to a child with VSD?

VSDs become haemodynamically apparent when pulmonary vascular disease occurs

Ace inhibitors reduce the systemic vascular system and this matches the pulmonary vascular system --> so short term management only


what are some medical short term options for large VSD?

diuretics like spironolactone and Lasix



what structural change of the heart is associated with ASD?

volume loading of the right heart (right ventricular dilation)


what is the key clinical implication of weak femoral pulses?

coarctation of the aorta


which gender is more predisposed to transposition of the great arteries?

male gender


what are the options for management of PDA (pulmonary ductus arteriosus)

Indomethacin for preterm

Surgery for symptomatic infant

Transcatheter closure for other child



where best on the praecordium can we hear VSD murmurs?

left lower sternal edge


where best on the praecordium can we hear a ASD murmur?

left upper sternal edge


how does inspiration/expiration change the second heart sound?

with inspiration= splitting of S2

with expiration= split narrows and becomes harder to hear


what causes the widely 'fixed' split S2 typical of ASD murmurs?

normally, S2 is split during inspiration as increasd systemic venous return overloads the right ventricle, thus delaying the closure of the pulmonary valve. In ASD, there is a left to right shunt. This means that the right ventricle is always overloaded regardless of respiration and thus the pulmonary valve has a delayed closure every time--> fixed wide S2 split heart sound


Generally pathological murmurs do not change in intensity when the child stands up. Which pathological murmur does NOT follow this rule? Why is this?

hypertrophic cardiomyopathy. Murmur increases as the child stands up.


Venous return decreases as the child stands up, leading to reduced left ventricular end diastolic volume. This narrows the left ventricular outflow tract (due to reduced blood volume) and consequently, systolic outflow obstruction increases --> increased intensity of murmur


where best on the praecordium may we hear the murmur of a PDA?

left upper sternal edge


how might we keep the pulmonary ductus arteriosus open?

with prostaglandins (E2) in the short term


what is this?

tetralogy of fallot


what might delay the presentation of coarctation of aorta?

may be delayed as the ductus remains open