acyonotic murmur

Question 1

New murmur differential

Answer 1

Benign: peripheral pulmonic stenosis, pulmonary flow murmur, stills murmur, venous hum

Common pathology: atrial septal defect, ventricular septal defect, semilunar valve stenosis (aortic vs pulmonic), AV valve regugitation Mitral vs tricuspid, patent ductus arteriosus, AV valve stenosis Mital vs tricuspid

Question 2

Murmur

Answer 2

audible tubulent sound sound waves

50-80% pop will have an innocent murmur during childhood

Question 3

ventricular septal defect

Answer 3

incidence: 20-30% of all defects, prevalence 2-4/1000 live births

VSDs are classified according to their relationship to anatomic landmarks on the right side of the septum (perimembranous, trabecular muscle, inlet or outlet)

Outlet: type 1, subarterial, supracristal, infracristal, conal septal defect, infundibular, doubly committed, subpulmonary

Perimembranous: type 2 paramembranous conoventricular

Inlet: type 3, AV canal type

Muscular: type 4 trabeculat

Question 4

perimembranous VSD

Answer 4

80% of VSDs (ventricular membrane)

Usually restrictive with Ventricular septal aneurysm formation- close spontaneosly

Can extend into adjacent inlet and outlet

Associated anomalies: subaortic stenosis, double chamber RV, aortic insufficiency, aortic insufficiency, LV–> Ra shunt

Question 5

Trabecular muscular VSD

Answer 5

Most common in infancy- frequent spontaneous closure

Usually restrictive and serpiginous can be multiple

location described by position in the trabecular septum (anterior, posterior, mid muscular, apical)

Associated anomalies: aortic coarctation, swiss cheese septum

Question 6

Inlet VSD

Answer 6

Rate defect in isolation- usually part of AVSD

Crux of the heart immediately below the AV valves is absent

Associated anomalies: malalignment between atrial and ventricular septa, AV valve override/straddle

Question 7

Outlet VSD

Answer 7

Usually associated with complex CHD
Isolated defect common in asian population
Can be subdivided into intracristal (subAo) and supracristal (subpulmonary)

Associated anomalies: amlignant conus septum anteriorly and aortic insufficiency

Question 8

VSD physiological effects

Answer 8

CHF secondary to large volume L-R shunt
Pulmonary HTN with eventual reversal of the shunt to R-L Eisenmengers syndrome

LV dysfunction as a late consequence of chronic volume overload

Bacterial endocarditis

Restrictive defect has resistance to shunt at the VSD= creates a gradient between LV and RV

Magnitude of the VSD shunt determined by VSD size and pulmonary vascular resistance

Question 9

VSD classification

Answer 9

based on size, predicted PA pressure and volume load

Small, restrictive defect with normal PA pressure and no LV volume overload

Moderate sized, restrictive defect subsystemic PA pressure and LV volume overload

Large defect with supra systemic PVR and R–> L shunt

Question 10

Common exam findings VSD

Answer 10

Harsh, medium to high frequency murmur that is thru out systole. Sometimes a diastolic flow rumble can be heard as well

Poor growth: normal infants usually need 80-100 cal/kg/day to grow

Poor feeding: tachypnea with feeds, increased time to feed , sweating with feeds, failure to thrive, hepatomegaly