Pediatric Heart Murmurs Flashcards
What 3 structures close at birth in the baby vasculature?
Foramen ovale
Ductus arteriosus
Ductus venosus
What 4 situations for infants do we do a full cardio exam?
Feeding intolerance
Failure to thrive
Respiratory symptoms
Cyanosis
What are the 4 situations where we do a full cardio exam on an older child?
Chest pain
Syncope
Exercise intolerance
Family history of sudden death
Regardless of age, what child do we always do a complete cardiac exam on?
Children with a murmur
What is included in a complete cardiac exam?5 things.
VS Pulses Perfusion, capillary refill Precordial inspection and palpation Auscultation
What are the 6 features he wants to know about murmurs?
Grade, timing, location of highest intensity, character, changes with position and does it radiate anywhere
What is important to remember about grade 4 murmur?
Palpate a thrill
What is his comment about murmurs and changes in position?
Most innocent murmurs will change with position.
Most pathological murmurs will not change with position
What are the different pulse grades?
0- absent 1 -weak 2 normal 3 increased 4 bounding
What is S3 and why can it be normal in kids?
It is blood hitting a very compliant left ventricle
What can cause a normal splitting of S2?
During inspiration, more blood is being returned to the right side of the heart so you have a little bit more volume overload on that side and it causes the pulmonic valve to close a little later than the aortic valve.
What is a FIXED splitting of S2 indicative of?
ASD
What type of murmur is an ASD?
Systolic
How does ASD cause a splitting of S2?
Volume overload on right side causing pulmonic to close later
What is the number 1 cause of holosystolic murmurs or obscuring at least s1 or s2?
VSD
What did he say about a diastolic murmur? 4 things.
Not normal, needs a work up, rumbling character, listen with a bell
What is the only sound in diastole that does not warrant a workup?
Venous hum
What is the most common innocent murmur in kids?
Stills murmur
What grade is a stills murmur, type and where can you hear it best?
1 or 2
Systolic ejection
Between Left sternal border and apex
How does the stills murmur change with position?
When the child stands it decreases in intensity
What is the difference between IHSS murmur and stills murmur?
IHSS gets louder when the patient stands up.
What are the 7 S’s of innocent murmurs?
Sensitive, short duration, single, small (non radiating), soft, sweet, systolic
What are the 5 cyanotic congenital heart defects?
Truncus arteriosus Transposition of the great vessels Tricuspid atresia Tetralogy of fall out Total anomalous pulmonary venous return
What is the test we do for critical congenital heart disease?
Take o2 sat from right arm and right foot and if there is a big difference we do an echo. if not, they are good. It is testing pre ductal and post ductal o2 sats
