Paediatric Cardiology - Heart Murmurs Flashcards
What is paediatric cardiology mainly concerned with?
- congenital heart defects
- screening and monitoring inherited disease e.g. Marfan
- acquired disease e.g. rheumatic fever
- arrhythmias, mainly SVT
What are the 8 most common congenital heart defects?
- VSD
- Patent ductus arteriosus
- ASD
- Pulmonary stenosis
- Aortic stenosis
- Coarctation of the aorta
- Transposition of the great arteries
- Tetralogy of Fallot
What are the causes of congenital heart defects?
- genetic susceptibility e.g. chromosomal abnormalities
- environmental hazard
- teratogenic insult days 18-60 post conception
What environmental factors can lead to congenital heart defects?
- drugs e.g. alcohol
- infections e.g. TORCH (toxoplasma, rubella, CMV, herpes)
- maternal e.g. diabetes, SLE
What congenital heart defect is associated with Turner syndrome?
coarctation of aorta
What congenital heart defect is associated with Noonan syndrome?
pulmonary stenosis
What congenital heart defect is associated with William’s syndrome?
supra valvular AS
What congenital heart defect is associated with 22q11 deletion syndrome?
VSD, amongst others
What signs might you get from a history that may suggest that a child may have a congenital heart defect?
- problems with feeding, weight and development
- central cyanosis
- lessened exercise tolerance
- breathlessness
What features on examination might make you suspicious of a cardiac defect?
- low weight and height
- dysmorphic features
- cyanosis
- clubbing
- tachypnoea
- feel femoral pulses!!
- murmurs
- hepatomegaly
What are signs of acute decompensation of heart failure in children?
- poor feeding
- dyspnoea
- tachycardia
- hepatomegaly
- cool peripheries
- acidosis on ABG
- pulmonary venous congestion on chest x ray
What investigations would you do in to congenital heart defects?
- ECG, 24 hrs
- ABG
- chest x ray
- catheter
- angiography
- MRI/MRI angiography
- exercise testing
- blood pressure
- oxygen saturation
How would you manage heart failure in an infant?
- sit upright
- oxygen
- calories via NG tube
- diuretics (furosemide)
- if have duct dependent cyanotic condition then will also require prostaglandin to keep duct patent
Where are the 4 places you might hear a murmur in children?
- upper right sternal border
- upper left sternal border
- lower left sternal border
- apex
Are innocent murmurs common in children?
yes - the majority are innocent murmurs
How many types of innocent murmur are there in children?
4
What are common features of innocent murmurs?
- they are systolic
- no other signs of cardiac disease
- soft murmur (grade 1 or 2/6)
- vibratory, musical e.g. ‘twang’, ‘buzz’
- localised i.e. no radiations
- varies with position, respiration, exercise
What are the 4 innocent murmurs?
- Still’s murmur
- pulmonary outflow murmur
- Carotid/brachiocephalic arterial bruits
- venous hum
In what age range of children can you generally detect Still’s murmur?
age 2-7 years
Where is Still’s murmur best heard and what does it sound like?
- best heard at apex or left sternal border
- tends to be soft systolic; vibratory, musical, ‘twangy’ like an elastic being pulled
What can make a Still’s murmur sound louder?
increases in supine position and with exercise
In what age range of children can you generally detect a pulmonary outflow murmur?
8-10 years
Where is a pulmonary outflow murmur best heard and what does it sound like?
- best heard upper left sternal border, is localised and will not radiate
- soft systolic; vibratory
What can make a pulmonary outflow murmur sound louder?
increases in supine position and with exercise
What is often a physical feature of a child who has a pulmonary outflow murmur?
a narrow chest
In what age range of children can you generally detect a carotid/brachiocephalic arterial bruit?
2-10 years
Where is a carotid/brachiocephalic arterial bruit best heard and what does it sound like?
- supraclavicular, radiates to neck
- 1/6-2/6 systolic; harsh in quality
What can make a carotid/brachiocephalic arterial bruit louder or abolish it?
- louder with exercise
- decreases on turning head or extending neck
In what age range of children can you generally detect a venous hum?
3-8 years
Where is a venous hum best heard and what does it sound like?
- supraclavicular
- continuous murmur, sometimes louder in diastole
- soft and indistinct
Is there anything that will accentuate the venous hum or make it disappear?
- heard only in upright position
- disappears on lying down or when turning head
