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Adv Prac Child Adolescent 6036 Test 2 > Module 5: (a) Pediatric Murmurs > Flashcards

Module 5: (a) Pediatric Murmurs Flashcards

1
Q

Murmurs

-Stats

A
  1. Nearly all children have murmurs at some time
  2. More likely to be heard during sick visits
  3. Usually benign
  4. May indicate structural heart disease
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2
Q

Evaluation of Murmurs

A
  1. Hx — Exercise tolerance, chestp pain, syncope, FH
  2. General PE — Growth, respirations, perfusion
  3. Palpation — Thrill, precordial activity
  4. Auscultation — S1, S2, clicks, murmurs
  5. Exercise tolerance in an infant — Trouble feeding, gets SOB when feeding **
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3
Q

Characteristics of Murmurs

A
  1. Timing — If you hear a murmur in only ONE part of the cardiac cycle it is almost always a SYSTOLIC murmur
    - If pulse is consistent with murmur, it is during systole **
    - Systolic + Diastolic Murmur — Aortic stenosis — two seperate components w/ silence between the two
    - Continuous murmur — PDA is example of continuous
  2. Character
    - Regurgitant murmur — VSD
    - Ejection
    - Pitch is determined by pressure.
    - Harsh, musical — Harsh has the sound of “sh” — Stills murmur has a musical character
  3. Location
    - Upper left sternal border — Pulmonary flow murmurs — Radiates to back
    - URSB — Aortic outflow murmurs — Radiate to carotids
    - LLSB — Ventricular septal defects
    - Apex — Mitral murmurs
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4
Q

Clicks

A
  1. Short, high-pitched sounds
  2. Usually indicate valvar abnormalities
  3. More similar to first and second heart sounds than they are different
  4. Two major types
    - Ejection clicks
    - Midsystolic clicks
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5
Q

Ejection Clicks

A
  1. Immediately after S1 — May be mistaken for split S1
  2. Aortic Clicks
    - Usually heard at apex
    - Constant throughout respiratory cycle
  3. Pulmonary clicks — Left sternal border and Louder w/ expiration
  4. Ventricular septal aneurysm — Left sternal border
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6
Q

Midsystolic Clicks

A
  1. Midway between S1 and S2
  2. Mitral Vlave Prolapse
    - Click heard best at apex
    - Accentuated by standing
    - Decreased by lying supine
    - Click is followed by regurgitant murmur
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7
Q

Normal Murmurs Stats

A
  1. Usually Systolic
  2. Less than grade 4/6 (NO THRILL)
  3. Generally increased w/ fever, anemia, anxiety, excitement
  4. Several specific types
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8
Q

Normal Murmurs

-Still’s Murmur

A
  1. Short, systolic murmur
  2. Vibratory, buzzing, honking
  3. Lower left sternal border
  4. Most common 3-8 years of age
  5. Louder supine and decreases w/ valsalva
  6. Typically resolve by adolescents
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9
Q

Normal Murmurs

-Pulmonary Flow Murmur

A
  1. Short, systolic ejection murmurs
  2. Upper left sternal borner
  3. All ages but RARE in infants
  4. Increases with supine position
  5. Increases w/ fever, anemia
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10
Q

Normal Murmurs

-Peripheral Pulmonic Stenosis

A
  1. Systolic Ejection murmur heard LOUDEST in axillae (especially right axilae)**
  2. Commonly heard in premature NEONATES
  3. Usually resolve by 1 year of age
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11
Q

Normal Murmurs

-Sypraclavicular Bruit

A
  1. Systolic Ejection murmur
  2. Supraclavicular region and neck — Sometimes heard below clavicles
  3. Not affected by sitting or lying
  4. Decreased by hyperextension of shoulders
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12
Q

Normal Murmurs

-Venous Hum

A
  1. Continuous (Louder in diastole)
  2. Supraclavicular — Right more common than left
  3. Disappears with changes in head position, digital pressure, lying supine
  4. Loudest when sitting or standing
  5. Caused by blood flow in jugular vein
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13
Q

Murmurs Needing Evaluation

-Info

A
  1. Murmurs in symptomatic kids
  2. Loud murmurs
  3. Diastolic murmurs
  4. Murmurs that don’t fit into categories of innocent murmurs
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14
Q

Congenital Heart Disease

-Presenting as an Asymptomatic Murmur

A
  1. Spetal defects — ASD, VSD
  2. Obsturciton to ventricular outflow
    - Valvar, subvalvar, or supravalvar Aortic or pulmonic stenosis
    - Coarctation of Aorta
  3. Patent ductus Arteriosus (PDA)
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15
Q

What causes Systolic Murmur

A
  1. Turbulence in ventricular outflow
    - Narrowing of aortic or pulmonary valve, aorta or pulmonary artery
    - Increased flow
  2. AV valve regurgitation
  3. Abnormal ventricular or acterial communications — VSD, PDA
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16
Q

Aortic Stenosis

A
  1. May be valvar, subvalvar or supravalvar
  2. Systolic ejection murmur — Upper right sternal border — Radiates to the neck
  3. May have thrill in suprasternal notch
  4. Valvar AS usually causes a systolic ejection click at apex
17
Q

Pulmonic Stenosis

A
  1. Systolic ejection murmur — Upper Left sternal border — Radiates to back
  2. Systolic ejection click at Lower left sternal border varies w/ respiration
  3. May have thrill in suprasternal notch
18
Q

Coarctation of the Aorta

A
  1. Narrowing of aortic arch adjacent to site of ductus
  2. Systolic ejection murmur below left scapula
  3. Decreased pulses and BP in lower extremities **
  4. If severe, causes shock
  • THINK OF COACTATION OF THE AORTA W/ ANY NEWBORN **
  • ANY BABY IN SHOCK, THINK COARCTATION AS WELL **

-THESE CHILDREN NEED INTUBATION **

19
Q

Ventricular Septal Defect

A
  1. Holosystolic Murmur — Harsh and high pitched if VSD is small
  2. Diastolic rumble at apex - Low pitched rumble — After S2 before S1 and check for sounds — Louder with bell
  3. If VSD is large it will lead to CHF
    - Increased LA pressure
    - Pulmonary edema
    - Increased WOB
    - Poor growth
    - Usually have Hepatomegaly from increased right atrial pressure
20
Q

Atrioventricular Septal Defect

A
  1. Left to right shunt (atrial and ventricular)
  2. Increased pulmonary blood flow
  3. Common AV valve
  4. Increased PA pressure
  5. Normal saturations
  6. High incidence with Down’s syndrome
21
Q

Posterior Rib Fractures

A
  1. Always a sign of NAT - Abuse
22
Q

Atrial Septal Defect

A
  1. Systolic Ejection murmur
  2. Upper left sternal border
  3. Wide fixed split S2
  4. Diastolic rumble at lower left sternal border
  5. CHF not generally seen
  6. Subtle exercise intolerance
23
Q

Normal Splitting of S2

-Inspiration

A
  1. Negative intrathoracic pressures increases systemic venous return
  2. Increases filling of RV and prolonged RV ejection
  3. Delays pulmonary valve closure making S2 split
  4. No change in pulmonary venous return
  5. No effect on LV filling
24
Q

Normal Splitting of S2

-Expiration

A
  1. Positive intrathoracic pressure decreases systemic venous return
  2. Decreases filling of RV and shortened RV ejection
  3. Pulmonary valve closure is earlier, making S2 single
  4. No change in pulmonary venous return
  5. No effect on LV filling
25
Q

ASD - Wide, fixed splitting of S2

A
  1. Left-to-right ASD flow increases RV filling, delays P2 causing wide splitting
  2. Inspiration increases systemic venous return, but decreases ASD flow
  3. Expiration decreases systemic venous return, but increases ASD flow
  4. Splitting does not vary with respiration
26
Q

What Causes Diastolic Murmurs?

A
  1. Turbulence in ventricular inflow
    - Narrowing and increased flow
  2. Semilunar valve regurgitation
27
Q

What Causes Continuous Murmurs?

A
  1. Abnormal connection between systemic to artery and a pulmonary artery — Ex: PDA
  2. Abnormal AV communications - AV Fistula & Coronary artery fistulae
28
Q

Common Murmurs in the First Few days of Life

-NORMAL

A
  1. Peripheral pulmonic stenosis
  2. Pulmonary flow murmur
  3. Transitional murmurs
    - Closing PDA
    - Transient tricuspid regurgitation
29
Q

Common Murmurs in the First Few days of Life

-Abnormal

A
  1. Outflow obstruction
    - Aortic stenosis
    - Pulmonary stenosis
    - Coarctation
  2. Abnormal Communications
    - Ventricular Septal defect
    - Patent ductus arteriosus
30
Q

Common Murmurs in the First Few days of Life

-NORMAL transitional Murmur — Closing PDA

A
  1. ULSB or left infraclavicular area
  2. Systolic or continuous
  3. Often louder as PDA gets smaller
  4. Typically 12-48 hrs of age
31
Q

Common Murmurs in the First Few days of Life

-Normal Transient Tricuspid Regurgitation

A
  1. LLSB
  2. Regurgitant, systolic
  3. Often seen in asphyxiated infants or infants w/ pulmonary hypertension
  4. Resolves over several days
32
Q

Common Murmurs in the First 6 months of Life

-Normal?

A
  1. Peripheral pulmonic stenosis

2. Pulmonary flow murmur

33
Q

Common Murmurs in the First 6 months of Life

-Abnormal

A
  1. Outflow obstruction
    - Aortic Stenosis
    - Pulmonary stenosis
    - Coarctation
  2. Abnormal communications
    - Ventricular septal defect
    - Patent ductus arteriosus
34
Q

Common Murmurs in the First few years of Life

-Normal

A
  1. Pulmonary Flow murmur
  2. Stills Murmur
  3. Venous hum
35
Q

Common Murmurs in the First few years of Life

-Abnormal

A
  1. Outflow obstructions
    - Aortic stenosis, pulmonary stenosis, coarctation
  2. Abnormal communications
    - VSD, ASD, PDA
36
Q

Common Murmurs in school aged children

-Normal & Abnormal

A
  1. Normal = All previous + Supraclavicular bruit

2. Abnormal = All previous + Hypertrophic cardiomyopathy

37
Q

Endocarditis Prophylaxis 2007

A
  1. Many fewer patients require prophylaxis than under previous recommendations
  2. Prophylaxis no longer recommended for GI or GU procedures
  3. Prophylaxis for oral procedures limited to selected high-risk patients
38
Q

Indications for Prophylaxis

A
  1. Prosthetic cardiac valve or previous endocarditis
  2. Congenial heart disease only in the following cateogories
    - Unrepaired cyanotic congenital HD
    - Completely repaired congenital HD w/ prostehtic material or device
    - Repaired congenital heart disease w/ residual defects
  3. Cardiac transplantation reciepts w/ cardiac valvular disease

Adv Prac Child Adolescent 6036 Test 2 (5 decks)

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