Murmur - ASD, VSD, PDA, Coarctation

Question 1

Patent ductus arteriosis
-pathophysiology
-risk factors
-presentation
-management

Answer 1

Connection between pulmonary trunk and descending aorta
-normally closes with first breaths from increased pulmonary flow and prostaglandin clearance

Premature
Maternal rubella in 1st trimester

Left subclavicular thrill
Continuous machinery murmur
Large volume, collapsing pulse
Wide pulse pressure
Apex beat

Indomethacin or ibuprofen => close connection

Question 2

ASD
-what is it
-types
-presentation
-management

Answer 2

Most likely to be detected in adults

Ostium primum - involvement of AV valve
Ostium secundum - involvement of foramen ovale

Ejection systolic murmur - from increased volume passing through pulmonary valve
Fixed split S2 - pressures are greater in RHS

May resolve
Surgical closure

Question 3

VSD
-causes
-presentation
-management
-complications

Answer 3

Chromosonal
-Downs, Edwards, Patau
Congenital infection

Found in 20wk anomaly scan
-failure to thrive
-HF - hepatomegaly, high HR, RR, pale but not cyanotic
pansystolic murmur

If asymptomatic, can close spontaneously - monitor
Symptomatic => HF in months
-nutritional support
-HF meds
-surgical closure of defect

Aortic regurg
IE
RHF
PHTN - pregnancy contraindicated due to high mortality
Eisenmenger’s complex

Question 4

Coarctation of aorta
-risk factors
-presentation

Answer 4

Turners - bicuspid AV

Infancy - HF
Adult - HTN
Radiofemoral delay
Mid systolic murmur, MAXIMAL OVER BACK
Apical click from AV
Notching of inferior border of ribs - from enlarged intercostal arteries

Question 5

Innocent murmurs
-characteristics

Answer 5

Soft blowing in pulmonary or aortic area
Varies with posture
No radiation
No diastolic component
No thrill
No added sounds
Asymptomatic
NAD