PEDIATRIC MURMURS Flashcards
Ventricular Septal Defect
- loud, harsh
- holosystolic murmur
- lower left sternal border
- palpable thrill
- increase peripheral vascular resistance will increase the murmur
- Hand-gripping and squatting increase peripheral vascular resistance and will increase a ventricular septal defect murmur.
- diastolic rumble/apical impulse
- MC patho murmur in childhood
- harsh, medium- to high-pitched pansystolic murmur is heard best at the left sternal border in the third and fourth intercostal spaces with radiation over the entire precordium
Patent Ductus Arteriosus
- continuous loud machine-like murmur
- left infraclavicular border that extends through systole and diastole
- pulmonic area
Hypertrophic Cardiomyopathy
- harsh, systolic crescendo-decrescendo murmur beginning just after S1 at the apex - left sternal border
- S4 w/ apical lift
OR
- holosystolic murmur loudest at the apex
- decreases with squatting/increase with valsalva or standing
Pulsus Alternans
change in amplitude that occurs with alternating beats secondary to changing systolic pressure
-hypertrophic cardiomyopathy
OR
-severe aortic regurgitation
Pulsus Paradoxus
marked decrease in arterial pressure
-cardiac tamponade
OR (less common)…..
- COPD
- hypovolemic shock
Water Hammer Pulse
abrupt, rapid upstroke of the peripheral pulse (percussion wave), followed by rapid collapse
-chronic aortic regurgitation
Atrial Septal Defect
- midsystolic murmur is often best heard at the second left intercostal space
- fixed and split S2 sound (due to the aortic valve closing prior to the pulmonic valve)
-can lead to R atrial enlargement
Rheumatic Fever
-late systolic rumbling murmur
mitral regurgitation is MC
Tetrology of Fallot (BOOT SHAPED HEART)
- harsh systolic crescendo-decrescendo murmur at the left sternal border, a palpable thrill, and a prominent right ventricular impulse
- RADIATION TO THE BACK
- harsh, systolic ejection murmur loudest at the left upper sternal border
- tet spells relieved w/ squat/knees to chest
- cyanotic
- worse w/ crying/feeding
Cervical Venous Humm - innocent murmur
-left or right upper sternal borders, infraclavicular area, or supraclavicular area. It is a continuous murmur that is accentuated with head extension while seated
Still murmur
-innocent cardiac murmur with a vibratory or musical quality that is heard best over the lower left sternal border.
Bicuspid Aortic Valve
- loud systolic ejection murmur at the left sternal border that radiates to the neck
- systolic ejection murmur with a crescendo-decrescendo quality, an ejection click, visible apical hyperactivity, and an increased left ventricular impulse
Coarctation of the Aorta
- late systolic ejection/continuos murmur –> radiates to left back/scapula or chest
- heard in the aortic area
