Paeds - cardio murmurs

Question 1

PDA: type of murmur and location

Answer 1

-Diastolic machinery (continuous) murmur best heard in the left upper sternal border

Question 2

PDA: timeline of closure, type of defect and presenting complaint

Answer 2

• Stops functioning by day 1-3 and closes by 2-3 day of life.
• L-R shunt due to increased aortic pressure

PC

• Associated with pulmonary hypertension, RV hypertrophy and eventually LV hypertrophy
• SOB +/- signs of HF
• Poor feeding/weight giant
• LRTI due to wet lungs

Question 3

PDA: investigations and management

Answer 3

• Echo will show direction of blood flow and RV hypertrophy

- If still open after one year (spontaneous closure unlikely) do transcatheter/surgical closure

Question 4

ASD: type of murmur and location?

Answer 4

• Mid systolic crescendo-decrescendo with fixed S2 split (pulmonary valve closes after aortic due to increased volume in RHS of heart)
• Best heard in left upper sternal border

Question 5

Outline the PC of ASDs and management

Answer 5

• Often found antenatally/NIPE and may be asymptomatic in childhood
• SOB
• Decreased feeding/wt gain/failure to thrive
• LRTI due to wet lungs

Management
-Refer to paeds cardio —> big ASD is fixed with trans venous catheter closure whilst smaller/asymptomatic ones are treated with W&W

Question 6

VSD: nature of murmur and location? What conditions are VSDs associated with?

Answer 6

• Pan systolic murmur +/- thrill or heave
• LLSB
• Associated with Down’s and Turner’s syndrome

Question 7

How do VSDs present? How are they managed?

Answer 7

• Often picked up antenatally
• Decreased feeding, dyspnea, tachypnea and failure to thrive

Management

• Small VSD without PHTN/HF: W&W
• Bigger VSD: transverse catheter closure or open heart surgery

Question 8

Pulmonary valve stenosis: type of murmur and area

Answer 8

-Ejection systolic murmur found in pulmonary area

Question 9

What conditions are associated with pulmonary valve stenosis?

Answer 9

• ToF
• Williams syndrome
• Noonan syndrome
• Congenital rubella syndrome

Question 10

What are some signs of pulmonary valve stenosis?

Answer 10

• Ejection systolic murmur
• Palpable thrill in pulmonary area
• Raised JVP with big A waves
• RV heave (associated with RV hypertrophy)

Question 11

How is pulmonary valve stenosis managed?

Answer 11

• Echo monitoring
• Mild: W&W
• Symptomatic patient: balloon valvuloplasty with enlarge valve

Question 12

Aortic stenosis: type of murmur and location

Answer 12

-Ejection systolic murmur found in aortic area

Question 13

Aortic stenosis: presenting complaint and signs?

Answer 13

• Mild: asymptomatic and usually incidental discovery
• Significant: fatigue, dizziness, fainting (worse on exertion), if severe will present with HF within months of life
• Signs: raising pulse, narrow pulse pressure

Question 14

Aortic stenosis: investigations and management

Answer 14

• Echo, ecg and exercise testing
• Percutaneous balloon aortic valvuloplasty
• Surgical aortic valvotomy/replacement