Heart Murmurs

Question 1

Still Murmur

Answer 1

• most common physiologic murmur
• most commonly during 2 mo old - preadolescent timeframe
• musical, vibratory, twanging, noisy systolic ejection murmur
• lower left sternal border and apex
• min to no radiation
• due to valve vibration
• inc with supine or hyperdynamic state (fever, anxiety); dec with valsalva or standing

Question 2

Cervical Venous Hum

Answer 2

• 2nd most common innocent pediatric murmur
• most common continuous innocent murmur
• ages 2-8
• continuous, soft, whirling, low pitch
• R sternal border, R infraclavicular area
• inc w/ empty heart, dec with full heart
• due to turbulent flow at jugular vein/SVC junction

Question 3

Pulmonary Ejection Murmur

Answer 3

• older children and adolescents
• harsh, midsystolic, LUSB
• blood going through pulm valve into pulm artery

Question 4

Atrial septal defect

Answer 4

• systolic ejection murmur, cresh-decresh
• RUSB (pulmonic area)
• mostly asymp, but may have emboli/stroke, fatigue, failure to thrive infant, dyspnea, syncope, palps
• echo = best diagnosis
• ECG shows RBBB, crochetage sign inf leads
• <5mm can be observed; >1 or asymp surgical or percutaneous transcatheter closure

Question 5

Patent ductus arteriosus

Answer 5

• continuous machinery-like murmur
• loudest at LUSB
• wide pulse pressure, loud s2
• echo to diagnose
• IV indomethacin or ibuprofen first line, surgical location or percutaneous catheter occlusion second line

Question 6

Tetralogy of Fallot

Answer 6

• 4 elements: pulmonic stenosis, RVH, VSD, overriding aorta
• r to l shunt
• cyanosis (blue baby syndrome), tet spells (relieved by knees to chest/squat), exertional dyspnea
• harsh systolic LUSB/left mid (vsd), right ventricular heave, digital clubbing, cyanosis
• echo = test of choice, cxr = boot shaped heart
• surg in first 4-12 mo
• prostaglandins prior to surgery
• Chrom 22 deletion

Question 7

Coarctation of aorta

Answer 7

• Systolic murmur radiating to back, scap, or chest

Question 8

ASD murmur

Answer 8

• Systolic, harsh, LUSB, cresh-decresh flow murmur

- widely split fixed S2

Question 9

PDA murmur

Answer 9

• continuous, machinery-like, LUSB

- wide pulse pressure

Question 10

Coarctation of the aorta murmur

Answer 10

• systolic, radiates to scap/back/chest

- delayed pulse/dec BP in LE

Question 11

Tetralogy of Fallot Murmur

Answer 11

• harsh, holosystolic, LUSB/left mid sternal (vsd)

- r ventricular heave