Acyanotic Heart Defects
Left →Right Shunting
↑Pulmonary blood flow
Obstruction to ventricular outflow
Atrial Septal Defect (ASD)
Coarctation of The Aorta
Ventricular Septal Defect (VSD)
Pulmonary Stenosis
Patent Ductus Arteriosus (PDA)
Aortic Stenosis Cyanotic Heart Defects
Right→Left Shunting
↓Pulmonary blood flow
Mixed Blood Flow
Tetralogy of Fallot
Transposition of the Great V essels
Tricuspid Atresia
Truncus Arteriosus
Hypoplastic Left Heart Syndrome
Critical Pulmonic Stenosis Systolic Murmurs
Diastolic Murmurs
Continuous Murmurs
●
Compromise most
murmurs heard
and occur
between S1 and
S2.
●
Are either
regurgitation
murmurs (e.g.,
holosystolic
murmur of a VSD
that begins with
S1 and continues
throughout
systole) or
ejection murmur
caused by flow of
blood through
narrowed or
stenotic areas
(e.g., AS) ●
Best heard at
second left or
right intercostal
space (ICS)
●
Begin with or after
S1 and before s2.
●
Include all
innocent and
physiologic
murmurs.
●
Typically occur
between S2 and
before or at S1.
●
Always indicate
cardiac pathology
●
Murmur that starts
with S2 and has
decrescendo
quality is most
commonly due to
aortic or pulmonic
regurgitation.
●
Mid-diastolic
“rumble,” a short
low-pitched
rumble heard best
at the apex, is
commonly due to
atrioventricular
valve stenosis or
increased flow
across a
nonstenotic valve,
such as seen with
a large VSD or
PDA.
●
Start at S1 and go
completely
through systole
and diastole.
●
Most common
cause is PDA.
●
These murmurs
need to be
differentiated from
the coexistence of
separate systolic
and diastolic
murmurs and
venous hums.
Innocent Murmur Usually grade I to III/VI in intensity and localized Changes with position (sitting to lying) May vary in loudness or presence from visit to visit May increase in loudness (intensity) with fever , anemia, exercise, or anxiety Musical or vibratory in quality , sometimes blowing Systolic in timing (except for venous hum, which is continuous), peaking in first half
of systole Duration is short Best heard in LLSB or pulmonic area (except for venous hum) Rarely transmitted May disappear with Valsalva maneuver , position, or gentle jugular pressure Vital signs: Normal ECG: Normal General health status: Good
Possible Pathologic Murmur A murmur in a child with a syndrome associated with CHD (e.g., trisomy 21) Any diastolic murmur Any systolic murmur associated with a thrill Pansystolic murmurs Continuous murmurs that cannot be suppressed Systolic clicks Opening snaps Fixed splitting of the second heart sound not associated with bundle branch block An accentuated S
2 S
4
gallops Not positional Grade IV/VI or higher Harsh quality Stills
Pulmonary
Flow
Murmur of Childhood
Pulmonary
Flow
Murmur of Infancy
Venous Ham
Other Names
Innocent Vibratory Functional Physiologic “Head start” murmur
Flow murmur
Peripheral pulmonary stenosis
.
Description Midsystolic, louder in supine position or with
inspiration
Early systolic to
midsystolic ; decreases or
disappears with
standing; increases with
Short,
midsystolic ejection murmur
Constant swish
Left →Right Shunting
↑Pulmonary blood flow
Obstruction to ventricular outflow
Atrial Septal Defect (ASD)
Coarctation of The Aorta
Ventricular Septal Defect (VSD)
Pulmonary Stenosis
Patent Ductus Arteriosus (PDA)
Aortic Stenosis Cyanotic Heart Defects
Right→Left Shunting
↓Pulmonary blood flow
Mixed Blood Flow
Tetralogy of Fallot
Transposition of the Great V essels
Tricuspid Atresia
Truncus Arteriosus
Hypoplastic Left Heart Syndrome
Critical Pulmonic Stenosis Systolic Murmurs
Diastolic Murmurs
Continuous Murmurs
●
Compromise most
murmurs heard
and occur
between S1 and
S2.
●
Are either
regurgitation
murmurs (e.g.,
holosystolic
murmur of a VSD
that begins with
S1 and continues
throughout
systole) or
ejection murmur
caused by flow of
blood through
narrowed or
stenotic areas
(e.g., AS) ●
Best heard at
second left or
right intercostal
space (ICS)
●
Begin with or after
S1 and before s2.
●
Include all
innocent and
physiologic
murmurs.
●
Typically occur
between S2 and
before or at S1.
●
Always indicate
cardiac pathology
●
Murmur that starts
with S2 and has
decrescendo
quality is most
commonly due to
aortic or pulmonic
regurgitation.
●
Mid-diastolic
“rumble,” a short
low-pitched
rumble heard best
at the apex, is
commonly due to
atrioventricular
valve stenosis or
increased flow
across a
nonstenotic valve,
such as seen with
a large VSD or
PDA.
●
Start at S1 and go
completely
through systole
and diastole.
●
Most common
cause is PDA.
●
These murmurs
need to be
differentiated from
the coexistence of
separate systolic
and diastolic
murmurs and
venous hums.
Innocent Murmur Usually grade I to III/VI in intensity and localized Changes with position (sitting to lying) May vary in loudness or presence from visit to visit May increase in loudness (intensity) with fever , anemia, exercise, or anxiety Musical or vibratory in quality , sometimes blowing Systolic in timing (except for venous hum, which is continuous), peaking in first half
of systole Duration is short Best heard in LLSB or pulmonic area (except for venous hum) Rarely transmitted May disappear with Valsalva maneuver , position, or gentle jugular pressure Vital signs: Normal ECG: Normal General health status: Good
Possible Pathologic Murmur A murmur in a child with a syndrome associated with CHD (e.g., trisomy 21) Any diastolic murmur Any systolic murmur associated with a thrill Pansystolic murmurs Continuous murmurs that cannot be suppressed Systolic clicks Opening snaps Fixed splitting of the second heart sound not associated with bundle branch block An accentuated S
2 S
4
gallops Not positional Grade IV/VI or higher Harsh quality Stills
Pulmonary
Flow
Murmur of Childhood
Pulmonary
Flow
Murmur of Infancy
Venous Ham
Other Names
Innocent Vibratory Functional Physiologic “Head start” murmur
Flow murmur
Peripheral pulmonary stenosis
.
Description Midsystolic, louder in supine position or with
inspiration
Early systolic to
midsystolic ; decreases or
disappears with
standing; increases with
Short,
midsystolic ejection murmur
Constant swish
