PAEDIATRIC CARDIOLOGY
Innocent Murmurs
Heart Failure
Cyanosis
Shock
Acynanotic conditions
Cyanotic conditions
PPHTN
SVT
On examination….
General inspection:
- Dysmorphia: Turner’s, Down’s, Williams
- Ask for height/weight chart
Central capillary refill
Palpate liver (hepatomegaly common sign of heart failure, do rather than JVP)
Auscultation
- Left intraclavicular (PDA)
- Innocent murmurs may be heard
Circulatory changes at birth
Fetus – LA pressure low, RA high as receives systemic venous return. FO allows blood
to flow from RA into LA then to body. Ductus arteriosus shunts blood from RV to aorta.
Birth – first breaths cause rise in LA pressure as pulmonary blood flow increases,
pressure changes close FO. DA (pulmonary artery to aorta) closes in first few
hours/days via fall in PGE.
Clearance of alveolar fluid over first 4h.
Checking heart is part of anomaly scan (18-20w). Echo if something is detected.
Especially interested if mother has DM/FHx heart problems.
, Innocent murmurs
40% children will have a murmur heard at some point – particularly if examined at a
state of high cardiac output (fever, anaemia, anxiety).
Re-examine asymptomatic healthy children 1-2w later when they are well.
8% pathologic in first 24 hours, 50% in neonatal period.
Still’s murmur (2-8y): near apex, vibratory/musical, Scott’s manoeuvre
(disappears in extension). DDx VSD.
Venous hum (late infancy/early childhood). DDx PDA.
Pulmonary flow murmur: ESM, DDx ASD.
These innocent murmurs have reassuring features:
- Asymptomatic
- Soft blowing murmur
- Systolic only
- Left Sternal edge (no radiation)
- No heaves or thrills
- Normal heart sounds, no clicks, normally split
- Varies with posture
If suspect pathological, then Echo is diagnostic (CXR/ECG not diagnostic).
Ejection systolic – innocent, aortic stenosis, pulmonary stenosis, coarctation, ASD
(split S2)
Pansystolic – VSD, mitral regurg, triscuspid regurg
Diastolic – aortic regurg, pulmonary regurg
Continuous – PDA, venous hum
Innocent Murmurs
Heart Failure
Cyanosis
Shock
Acynanotic conditions
Cyanotic conditions
PPHTN
SVT
On examination….
General inspection:
- Dysmorphia: Turner’s, Down’s, Williams
- Ask for height/weight chart
Central capillary refill
Palpate liver (hepatomegaly common sign of heart failure, do rather than JVP)
Auscultation
- Left intraclavicular (PDA)
- Innocent murmurs may be heard
Circulatory changes at birth
Fetus – LA pressure low, RA high as receives systemic venous return. FO allows blood
to flow from RA into LA then to body. Ductus arteriosus shunts blood from RV to aorta.
Birth – first breaths cause rise in LA pressure as pulmonary blood flow increases,
pressure changes close FO. DA (pulmonary artery to aorta) closes in first few
hours/days via fall in PGE.
Clearance of alveolar fluid over first 4h.
Checking heart is part of anomaly scan (18-20w). Echo if something is detected.
Especially interested if mother has DM/FHx heart problems.
, Innocent murmurs
40% children will have a murmur heard at some point – particularly if examined at a
state of high cardiac output (fever, anaemia, anxiety).
Re-examine asymptomatic healthy children 1-2w later when they are well.
8% pathologic in first 24 hours, 50% in neonatal period.
Still’s murmur (2-8y): near apex, vibratory/musical, Scott’s manoeuvre
(disappears in extension). DDx VSD.
Venous hum (late infancy/early childhood). DDx PDA.
Pulmonary flow murmur: ESM, DDx ASD.
These innocent murmurs have reassuring features:
- Asymptomatic
- Soft blowing murmur
- Systolic only
- Left Sternal edge (no radiation)
- No heaves or thrills
- Normal heart sounds, no clicks, normally split
- Varies with posture
If suspect pathological, then Echo is diagnostic (CXR/ECG not diagnostic).
Ejection systolic – innocent, aortic stenosis, pulmonary stenosis, coarctation, ASD
(split S2)
Pansystolic – VSD, mitral regurg, triscuspid regurg
Diastolic – aortic regurg, pulmonary regurg
Continuous – PDA, venous hum
