Lecture 3: Pediatric Heart Murmurs

Question 1

What are the 3 major closures in the CV system seen at birth as there is transition from intra-uterine to extra-uterine circulation?

Answer 1

1. Foramen ovale closes
2. Ductus arteriosus closes (forms ligamentum arteriosum)
3. Ductus venosus closes (forms ligamentum venosum)

Question 2

What are 5 signs and symptoms indicative of cardiac disease/abnormal cardiac function in an infant?

Answer 2

• Feeding intolerance (sweating, head bobbing)
• Failure to thrive
• Respiratory sx’s
• Cyanosis

Question 3

What are 4 signs and symptoms indicative of cardiac disease/abnormal cardiac function in an older child?

Answer 3

• Chest pain (exercise related that CAN’T be attributed to MSK pain)
• Syncope
• Exercise intolerance
• Family hx of sudden death in young people

Question 4

What are the 6 components needed when describing and documenting a cardiac murmur?

Answer 4

• Grade
• Timing
• Location of highest intensity
• Character
• Changes w/ position
• Radiation

Question 5

What are the 4 P’s associated with the complete pediatric cardiac exam?

Answer 5

• Pulses
• Perfusion (capillary refill)
• Precordial inspection and Palpation

Question 6

A “thrill” is caused by blood doing what?

Answer 6

Flowing from high pressure —> lower pressure

Question 7

Which heart sound may be associated with a normal“split” on inspiration?

Answer 7

S2

Question 8

Which sound auscultated during pediatric cardiac exam is indicative of ASD?

Answer 8

FIXED split S2

Question 9

What are 4 cause of an inaudible S1 and potentially S2 (holosystolic) murmur in a pediatric pt?

Answer 9

• VSD
• AV valve regurgitation murmur
• PDA
• Severe pulmonary artery stenosis

Question 10

Are diastolic murmurs a normal finding in pediatric pt?

Answer 10

Never normal on its own

Question 11

What is the only sound in diastole that does not warrant a referral to cardiology for pediatric pt?

Answer 11

Venous hums

Question 12

What is an exception to the rule of most murmurs not changing significantly with standing?

Answer 12

Hypertrophic cardiomyopathy

Question 13

Describe the murmur associated with hypertrophic cardiomyopathy; heard best where; and how does it change with position?

Answer 13

• Harsh, crescendo-decrescendo systolic murmur
• Best heard at apex
• ↑ in intensity when pt stands AND w/ valsalva maneuver

Question 14

What is a Still’s Murmur and how does it change in intensity?

Answer 14

• Innocent murmur (vibratory functional murmur)
• Decreases in intensity w/ inspiration, sitting, and standing

Question 15

What are the 5 cyanotic congenital heart defects that can be remembered with 1, 2, 3, 4, 5?

Answer 15

• One big trunk: Truncus arteriosus
• Two interchanged vessels: Transposition of Great Vessels
• Three: Tricuspid Atresia
• Four: Tetralogy of Fallot
• Five words: Total Anomalous Pulmonary Venous Return

Question 16

Describe the process used to diagnose critical congenital heart disease in the nursery using oxygen saturation?

Answer 16

O₂ saturations are checked pre-ductal and post-ductal –> check right foot and right arm

Question 17

What are the congenital cardiac defects common in children with Trisomy 21?

Answer 17

• AVSD –> constant overfilling of R side of heart –> pulmonary HTN
• VSD
• Tetralogy of Fallot