Level 2 - CVD Flashcards
What is an innocent murmur?
- Parasternal low-frequency ‘twangs’ in early systole
What is Still’s murmur?
Mid-left sternal border, mid-systolic grade 2-3, muscial vibratory sound
What is pulmonary flow murmur?
Upper left sternal border, mid-systolic, grade 1-2, grating
What is venous hum?
Right and/or left infraclavicular continuous, heard in upright position, diastolic compenent louder than systolic
What is a carotid bruit?
Supraclavicular area, ejection systolic, grade 2-3
What is peripheral pulmonary stenosis? (pulmonary flow murmur of newborn)
Upper left sternal border, grade 1-2, radiates to axillae and back, usually disappears by 6 months
Epidemiology of innocent murmur?
- 80% of children have innocent murmur at some point in time
Risk Factors of innocent murmur?
o Fever
o Anaemia
o Anxiety
o Exercise
What are innocent murmurs due to?
- Due to increased cardiac output
Symptoms of innocent murmurs?
- Innocent murmur (4 S’s)
o Asymptomatic patient
o Soft blowing murmur
o Systolic murmur
o Left Sternal edge
o Sensitive (changes with child’s position)
What signs in innocent murmurs?
- Normal heart sounds, no parasternal thrill, no radiation
- No clubbing, cyanosis, rib recession, arrhythmias, normal pulses
DDx of innocent murmur?
- Pathological murmur – congenital heart defects
Investigations in innocent murmur?
Usually none
- If pathological suspected:
o Echocardiogram gold standard
o Chest X-ray and ECG may mislead
Management of innocent murmur?
- Once a heart murmur is confirmed to be innocent, reassurance to the family regarding its benign nature is important
- Although the murmur may never disappear and may persist into adulthood, the parent and child need to be specifically reassured that an innocent murmur is simply an additional noise audible to the clinician
