4.8 Murmurs Flashcards
Are murmurs common in kids
yes
Up to 80% of children may have an innocent or “functional” murmur at some time during childhood.
Can develop at anytime during infancy or childhood
What is the cause of innocent or “functional” murmurs in childhood
these are benign murmurs
innocent murmurs are caused by **turbulent blood flow **through normal cardiac structures
Innocent murmurs are most often caused by turbulent blood flow through the pulmonary arteries or a slightly patent ductus arteriosus from delayed cardiac development in the neonate or prematurity.
Conversely, pathologic heart murmurs are most commonly associated with a ventricular septal defect or a more severe patent ductus arteriosus, and may also result from congenital heart disease
What types of things intensify murmurs
3
things that increase cardiac output like
* fever
* anemia
* exercise
murmurs can come and go
Do significant heart defects always present with a murmur
no- there may not be turbulent flow like with a large septal defect
Describe S2 in children
split during inspiration
because pulmonic valve closure lags behind aortic valve closure.
S2 becomes single with expiration. The intensity of splitting of S2 is one of the most important parts of the cardiac examination.
What does wide splitting of S2 without becoming a single sound on
expiration indicate
increased pulmonary flow (typical
of atrial septal defect)
If S2 is a single sound that does not split what is indicated
absence of one of the semilunar valves
like in pulmonary atresia
For a child with a murmur when is a referral to peds cardiology needed
2
- if dx is uncertain
- suspicion of heart disease
Do activities need to be limited or have special precautions for kids with murmurs
no
Tabe 38.4
Fig 38.3
box 38.3
table 38.5
Are asymptomatic murmurs always benign
no- can also be pathologic
but pathologic murmurs are less common in kids
Recall
Normal auscultation of heart:
- the first heart sound (S1) is heard as the atrioventricular valves (mitral and tricuspid) close and ventricular systole begins,
and the second heart sound (S2) is heard as the semilunar valves(aortic and pulmonic) close and ventricular diastole begins
no other heart sounds are heard and the heart rhythm is in a regular pattern
When a murmur exists, an atypical heart sound is heard that may occur at various times throughout the course of the cardiac cycle depending upon the type and cause of the murmur.
What are the 3 things that produce heart murmurs
- turbulent blood flow through vasculature or a normal or abnormal opening in the heart
- blood flow traveling forward through a narrowed valve into a dilated heart chamber or vessel
- blood flow traveling backward or regurgitating into a previous heart chamber through an incompetent valve
How are cardiac murmurs often described
3
harsh quality
blowing
musical sound
The diaphragm of the stethoscope is most useful for hearing sounds with ____ pitch, whereas the bell is best for sounds with ___ pitch
The diaphragm of the stethoscope is most useful for hearing sounds with higher pitch, whereas the bell is best for sounds with lower pitch
