Child health- murmurs Flashcards
what are ‘innocent’ or flow murmurs?
common murmur
fast blood flow in systole
typical features all start with an S
soft
short
systolic
symptomless
situation dependent (quieter when standing, only appears when child is feverish)
which features of a murmur prompt referall?
murmur louder than 2/6
diastolic murmur
louder on standing
other symptoms eg failure to thrive, feeding difficulty, cyanosis, SOB
describe pan systolic murmurs
occur throughout systolic contraction
between first and second heart sounds (s1 and s2)
what are the causes of pan systolic murmurs
mitral regurgitation (heard loudest in mitral area)
tricuspid regurgitation (heard best in tricuspid area)
ventricular septal defect (loudest at left lower sternal border)
describe ejection systolic murmurs
occur during systole between s1 and s2.
crescendo-decrescendo character
causes of pan systolic murmurs in children?
aortic stenosis (heard loudest in aortic area)
pulmonary stenosis (heard loudest in pulmonary area)
hypertrophic obstructive cardiomyopathy (loudest in 4th intercostal space at left sternal border
what is the second heart sound caused by?
closing of the aortic and pulmonary valveswha
what causes a split in the second heart sound?
aortic and pulmonary valves close at different times
when is a split second heart sound normal
during inspiration
when is a fixed splitting of the second heart sound heard?
in atrial septal defects
fixed refers to the split being present when the patient is not inspiring
when is a wide splitting of the second heart sound heard
pulmonary valve stenosis
what investigations would you give for a murmur of concern
echocardiogram is the gold standard
additional:
ECG
Chest Xray
