11: Cardiac Murmurs

Question 1

An electrical dysrhythmia that requires immediate treatment. Presentation includes sudden onset of rapid regular rhythm (>230 bpm—does not slow when infant is quiet), irritability, poor nippling, vomiting, tachypnea, cyanosis or ashen gray color, cold extremities.

Answer 1

Paroxysmal SVT

Question 2

May also detect diminished to absent femoral pulses.

Answer 2

Coarctation of the aorta

Question 3

A harsh, continuous, machinery-type or “rolling thunder” murmur.

Answer 3

Patent ductus arteriosus

Question 4

It is secondary to turbulence caused by blood flow from the main pulmonary arteries to the peripheral pulmonary arteries, which are smaller than usual.

Answer 4

Peripheral pulmonic stenosis

Question 5

Gallop rhythm; always abnormal and indicates congestive failure.

Answer 5

S4

Question 6

A gallop is usually heard.

Answer 6

Hypoplastic left heart syndrome

Question 7

Closure of aortic/pulmonic valves after ventricular ejection of blood.

Answer 7

S2

Question 8

A short midsystolic murmur can be heard beginning on day 1 or 2.

Answer 8

Hypoplastic left heart syndrome

Question 9

A systolic ejection murmur that radiates down the sternum to the apex and also to the interscapular area.

Answer 9

Coarctation of the aorta

Question 10

Produced by vibration during ventricular filling; can be normal in the newborn.

Answer 10

S3

Question 11

This murmur is benign, although it may persist until 3 months of age.

Answer 11

Peripheral pulmonic stenosis

Question 12

Typically, a loud, harsh, blowing pansystolic murmur.

Answer 12

Ventricular septal defect

Question 13

Localized to the second left intercostal space. It may radiate to the left clavicle or down the left sternal border.

Answer 13

Patent ductus arteriosus

Question 14

Closure of tricuspid/mitral valves after atrial ejection of blood.

Answer 14

S1

Question 15

It is often heard loudest in the back.

Answer 15

Coarctation of the aorta

Question 16

The most common heart defect, accounting for 25% of cases of congenital heart disease.

Answer 16

Ventricular septal defect

Question 17

Slight separation of valve sounds is evident after 24–48 hours of age and can result in this.

Answer 17

Split sound

Question 18

Single S2 with click and systolic blood pressure differential of >20 mm Hg between upper and lower extremities may indicate _____.

Answer 18

Coarctation

Question 19

A systolic murmur is heard bilaterally in both axillae and across the back.

Answer 19

Peripheral pulmonic stenosis

Question 20

Best heard over the lower left sternal border, usually on the second or third day of life.

Answer 20

Ventricular septal defect

Question 21

It usually presents on the second or third day of life. A hyperactive precordium, bounding pulses, and wide pulse pressure may be found.

Answer 21

Patent ductus arteriosus