Cardiac Murmurs

Question 1

Innocent murmurs

Answer 1

Characteristics of an innocent ejection murmur include:
-soft-blowing murmur in the pulmonary area or
-short buzzing murmur in the aortic area
-may vary with posture
-localised with no radiation
-no diastolic component
-no thrill
-no added sounds (e.g. clicks)
-asymptomatic child
-no other abnormality

Innocent murmurs heard in children include

1. Ejection murmurs
   Due to turbulent blood flow at the outflow tract of the heart
2. Venous hums
   Due to the turbulent blood flow in the great veins returning to the heart. Heard as a continuous blowing noise heard just below the clavicles
3. Still’s murmur
   Low-pitched sound heard at the lower left sternal edge

Question 2

Congenital heart disease: types

Answer 2

Acyanotic - most common causes
-atrial septal defect (ASD)
-ventricular septal defects (VSD) - most common, accounts for 30%
-patent ductus arteriosus (PDA)
-coarctation of the aorta
-aortic valve stenosis

VSDs are more common than ASDs. However, in adult patients ASDs are the more common new diagnosis as they generally presents later

Cyanotic - most common causes
-tetralogy of Fallot
-transposition of the great arteries (TGA)
-tricuspid atresia

Overall TOF more common than TGA. However, at birth TGA is the more common than TOF