Pathophys and Clinical Pres of Heart Murmurs

Question 1

Aortic stenosis

Answer 1

crescendo decrescendo murmur after S1 and after an atrial kick
results from a stenotic aorta

Question 2

Mitral regurgitation

Answer 2

mitral valve does not close during systole

holosystolic murmur after s1

Question 3

aortic regurgitation

Answer 3

aortic valve does not close during

diastolic decrescendo murmur

Question 4

mitral stenosis

Answer 4

follows opening snap during diastole

late diastolic murmur

Question 5

secundum asd

Answer 5

most common asd
deficiency or perforation of septum primum
rarely signficant in infancy, but gets more symptomatic with age
L to right shunt–> right heart volume overload
wide fixed splitting of second heart sound
systolic ejection (crescendo-decrescendo) due to inc pulmonic flow

Question 6

primum ASD

Answer 6

failure of fusion of septum primum to endocardial cushions
partial fusion of superior and inferior cushions with cleft in anterior mitral valve leaflet

holosystolic murmur with mitral regurg, otherwise similar presentation to secundum asd

Question 7

sinus venosus asd

Answer 7

anomalous drainage of one or more right pulmonary veins- draining into right heart instead of left
presentation same as secundum asd

Question 8

complete atrioventricular canal

Answer 8

lack of fusion of superior and inferior endocardial cushions
primum asd, inlet vsd , common av valve

infants present with chf symptoms- tachycardia, tachypnea, poor feeding, failure to thrive
loud s2, systolic ejection murmur at left sternal border due to inc pulmonic flow, holosystolic murmur due to av valve regurg if significant
surgical repair within 3-6 mos

Question 9

vsd

Answer 9

31% of chd
depends on size of defect
tachypnea, feeding difficulties, failure to thrive, pulmonary htn

left to right shunt, so kids will not be cyanotic

Question 10

vsd large defect m

Answer 10

large defect- systolic ejection murmur at left sternal border, mid diastolic murmur at apex

Question 11

vsd restrictive defect

Answer 11

holosystolic murmur at left sternal border

Question 12

pda

Answer 12

ductus arteriosus typically closes few days after birth due to inc oxygen tension after birth and removal of placental prostaglandin

pda is common in preterm infants
associated with rubella exposure in 1st trimester

Question 13

moderate to large pda

Answer 13

chf, failure to thrive
wide pulse pressure, bounding pulses, continuous machine like murmur
untreated- rapid development of pulmonary vascular disease and pulmonary htn

tx- surgical ligation for large defects, transcatheter device placement with small defects

Question 14

conotruncal formation

Answer 14

lefward shift of conotruncus to override muscular septum
septation of contruncus (persistent truncus arteriosus)
spiraling of outflow tracts (transposition of great arteries, tetralogy of fallot)

Question 15

double outlet right ventricle

Answer 15

failure of leftward shift of conotruncus
aorta and pulm artery arise from right ventricle
vsd may be present

Question 16

tetralogy of fallot

Answer 16

incomplete shifting of conotruncus results in anterior deviation of conotruncal septum and aorta overriding ventricular septum

pulmonary stenosis
thickened rv wall (right to left shunt)
vsd
aorta overrides septal defect

Question 17

tetralogy of fallot presentation

Answer 17

harsh long systolic ejection murmur radiating to both axillae and back
cyanosis dependent on severity
hypercyanotic spells can result from obstruction from muscle in right ventricular outflow tract

Question 18

transposition of great arteries

Answer 18

failure of spiraling of great vessels resulting in discordant ventriculo-arterial connection
severe cyanosis is present, survival dependent on patency of foramen ovale and ductus arteriosus to allow mixing of oxygenated and deoxygenated blood

Question 19

transposition of great arteries tx

Answer 19

prostin infusion, balloon atrial septostomy followed by surgical repair

Question 20

truncus arteriosus

Answer 20

failure of septation of truncus resulting in common arterial trunk exiting heart
large vsd, normal av connections
infants have severe chf
surgery required

Question 21

coarctation of aorta

Answer 21

narrowing of aorta

high blood pressure in arms, low in legs
leg pain, cramping 
tiring easily 
systolic murmur at right upper sternal border 
diminished femoral pulses
lvh