Murmers

Question 1

What are signs of an innocent ejection murmer?

(4+3)

Answer 1

• Asymptomatic patient
• Soft blowing murmur
• Systolic murmer only, not diastolic
• Left sternal edge murmer

Also:

• Normal heart sounds with no added sounds
• No parasternal thrill
• No radiation

Question 2

Why are innocent or flow murmers often heard during febrile illness or anaemia?

Answer 2

• Because of increased cardiac output
• Therefore important to assess child once other illnesses have been treated

Question 3

Why do many newborn infants with potential shunt have neither symptoms or a murmer at birth?

When does the murmer become apparent?

Answer 3

• As pulmonary vascular resistance is still high at birth
• Conditions such as VSD or ductus arteriosus may only become apparent at several weeks of age when the pulmonary vascular resistance falls

Question 4

What is a venous hum?

Where is it heard?

Answer 4

• A common & harmless condition found in children
• Can be heard above the right clavicle and over the right jugular vein

Question 5

Why does the venous hum occur?

When will the sound disappear?

Answer 5

• The flow of blood in the right jugular vein causes the vein walls to vibrate and this creates a humming noise
• The hum is heard throughout the cardiac cycle and placing a finger on the jugular vein will abolish the sound
• The murmer may disappear if pt is supine or if pt turns their head to one side