Pediatric Heart Murmurs

Question 1

What 3 structures close at birth in the baby vasculature?

Answer 1

Foramen ovale
Ductus arteriosus
Ductus venosus

Question 2

What 4 situations for infants do we do a full cardio exam?

Answer 2

Feeding intolerance
Failure to thrive
Respiratory symptoms
Cyanosis

Question 3

What are the 4 situations where we do a full cardio exam on an older child?

Answer 3

Chest pain
Syncope
Exercise intolerance
Family history of sudden death

Question 4

Regardless of age, what child do we always do a complete cardiac exam on?

Answer 4

Children with a murmur

Question 5

What is included in a complete cardiac exam?5 things.

Answer 5

VS
Pulses
Perfusion, capillary refill
Precordial inspection and palpation
Auscultation

Question 6

What are the 6 features he wants to know about murmurs?

Answer 6

Grade, timing, location of highest intensity, character, changes with position and does it radiate anywhere

Question 7

What is important to remember about grade 4 murmur?

Answer 7

Palpate a thrill

Question 8

What is his comment about murmurs and changes in position?

Answer 8

Most innocent murmurs will change with position.

Most pathological murmurs will not change with position

Question 9

What are the different pulse grades?

Answer 9

0- absent
1 -weak
2 normal
3 increased
4 bounding

Question 10

What is S3 and why can it be normal in kids?

Answer 10

It is blood hitting a very compliant left ventricle

Question 11

What can cause a normal splitting of S2?

Answer 11

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.

Question 12

What is a FIXED splitting of S2 indicative of?

Answer 12

ASD

Question 13

What type of murmur is an ASD?

Answer 13

Systolic

Question 14

How does ASD cause a splitting of S2?

Answer 14

Volume overload on right side causing pulmonic to close later

Question 15

What is the number 1 cause of holosystolic murmurs or obscuring at least s1 or s2?

Answer 15

VSD

Question 16

What did he say about a diastolic murmur? 4 things.

Answer 16

Not normal, needs a work up, rumbling character, listen with a bell

Question 17

What is the only sound in diastole that does not warrant a workup?

Answer 17

Venous hum

Question 18

What is the most common innocent murmur in kids?

Answer 18

Stills murmur

Question 19

What grade is a stills murmur, type and where can you hear it best?

Answer 19

1 or 2
Systolic ejection
Between Left sternal border and apex

Question 20

How does the stills murmur change with position?

Answer 20

When the child stands it decreases in intensity

Question 21

What is the difference between IHSS murmur and stills murmur?

Answer 21

IHSS gets louder when the patient stands up.

Question 22

What are the 7 S’s of innocent murmurs?

Answer 22

Sensitive, short duration, single, small (non radiating), soft, sweet, systolic

Question 23

What are the 5 cyanotic congenital heart defects?

Answer 23

Truncus arteriosus
Transposition of the great vessels
Tricuspid atresia 
Tetralogy of fall out
Total anomalous pulmonary venous return

Question 24

What is the test we do for critical congenital heart disease?

Answer 24

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

Question 25

What condition do you always do a cardiac work up for?

Answer 25

Down syndrome

Question 26

What is the study of choice for murmurs?

Answer 26

Echo with Doppler