2 - Paeds - CVS - Heart murmurs

Question 1

most common what?? but?

Answer 1

most common presenting feature of congenital HD

but vast majority have normal heart - innocent murmur heard in ~30% of kids at some point

Question 2

features of an innocent murmur

Answer 2

9 S's:
Soft
Systolic
Short
Site doesnt change (no radiation)
Sounds normal
Symptomless
Special tests normal 
Standing/Sitting (vary with position)
left Sternal edge

Question 3

when are innocent murmurs likely to be heard? so whats important to do?

Answer 3

during febrile illness/anaemia -> incr cardiac output

- important to examine once these are corrected

Question 4

if uncertain whether murmur is innocent? what may help if not neonate?

Answer 4

experienced paediatrician referral, to decide if to refer to paed cardiologist for an echo

CXR and ECG may help if beyond neonate

Question 5

no Sx or murmur at birth -> many still have…? why no Sx/murmur? therefore, what may present later on?

Answer 5

may still have a potential shunt, pulm vasc resistance is still high, conditions like VSD and PDA may only present at several weeks when pulm resistance falls

Question 6

what is a venous hum? why do you get the hum?

Answer 6

common and harmless hum heard over right clavicle and over right jugular vein

bl flow vibrates vessel walls > humming noises

Question 7

features of venous hum

Answer 7

heard throughout cardiac cycle, abolished by light pressure on JV/pt supine/pt turning head to one side