Heart Murmurs

Murmurs may be systolic, diastolic or continuous. Systolic Murmur Grades based on the intensity of the murmur. I/VI: Barely audible ... Cardiology AChapterinCoreConceptsofPediatrics,2ndEdition printall Contents Intro Cardiology Cycle TheCardiacCycle PhasesoftheCardiacCycle: Sounds HeartSoundsandMurmurs Murmers HeartMurmurs SystolicMurmurGradesbasedontheintensityofthemurmur SummaryofHeartMurmers Systolic Diastolic Continuous LRShunts LefttoRightShunts VSD VentricularSeptalDefects Anatomy Pathophysiology ClinicalPresentations Makingthediagnosis NaturalHistory Management PatentDuctusArteriosusAnatomy Anatomy Pathophysiology Clinicalpresentations Makingthediagnosis Naturalhistoryandmanagement AtrialSeptalDefects(ASDs) Anatomy Pathophysiology Clinicalpresentation Makingthediagnosis Management AtrioventricularDefect(AVSD) Anatomy Pathophysiology Clinicalpresentations Makingthediagnosis Management QuickChecks Obstruct ObstructiveCardiacLesions Arterialswitch(PS) Anatomy Clinicalpresentations Makingthediagnosis Management AorticStenosis(AS) Anatomy Clinicalpresentation Makingthediagnosis Management CoarctationoftheAorta Anatomy Pathophysiology Clinicalpresentation Makingthediagnosis Management QuickChecks DTGA CyanoticCardiacLesions CompleteTranspositionoftheGreatArteries(D-TGA) Anatomy Pathophysiology Clinicalpresentation MakingtheDiagnosis Management LTGA CorrectedTranspositionoftheGreatArteries(L-TGA) Pathology Makingthediagnosis Management PersistentTruncusArteriosus(TA) Anatomy Pathophysiology ClinicalPresentation MakingtheDiagnosis Management TetralogyofFallot(TOF) Anatomy(figure) Pathophysiology Clinicalmanifestations MakingtheDiagnosis Management TOFwithPulmonaryAtresia: TOFwithAbsentPulmonaryValve: TotalAnomalousPulmonaryVenousConnection(TAPVC) Pathophysiology Clinicalmanifestations MakingtheDiagnosis Management TA TricuspidAtresia(TA) Clinicalpresentation,EKGand,imaging Management PulmonaryAtresiawithIntactVentricularSeptum(PA-IVS) Clinicalpresentation,EKG,imaging Management EbsteinAnomalyoftheTricuspidValve(EA) Clinicalpresentations,EKG,imaging Management HypoplasticLeftHeartSyndrome Pathophysiology Clinicalpresentations MakingtheDiagnosis Management SurgicalmanagementofHLHS: CMyo Cardiomyopathies&Myocarditis Cardiomyopathies Dilatedcardiomyopathy Pathology Pathophysiology Clinicalpresentation Makingthediagnosis Management Pericard ConstrictivePericarditis Clinicalpresentation: Makingthediagnosis: Management: RCMyo RestrictiveCardiomyopathy Clinicalpresentation: Makingthediagnosis: Management: Myocarditis Clinicalpresentation Makingthediagnosis Management HypertrophicObstructiveCardiomyopathy Pathology ClinicalPresentation Makingthediagnosis Management Pain ChestPain Causesofchestpaininchildren Evaluationofchestpaininchildren Management EKGInte PediatricEKGInterpretation BeforeyoureadtheEKG,lookfor: BasicEKGinterpretation Arrhythm Arrhythmias Bradyarrhythmias Sinusbradycardia AtrioventricularBlock FirstdegreeAVblock SeconddegreeAVblock ThirddegreeAVblock Tachyarrhythmias Sinustachycardia Prematureatrialcomplexes(PACs) AtrialFlutterandAtrialFibrillation SupraventricularTachycardia(SVT) Ventriculararrhythmias Prematureventricularcontractions(PVCs) Ventriculartachycardia(VT) VentricularFibrillation(VF) LQTS LongQTSyndrome(LQTS) Pathophysiology Clinical MakingtheDiagnosis Management QuickCheck Kawasaki KawasakiDisease(MucocutaneousLymphNodeSyndrome) Pathogenesis Clinicalpresentation MakingtheDiagnosis ClassicKDisdiagnosedbythefollowingcriteria: Otherclinicalsigns: Management(Figure): References Endocard InfectiveEndocarditis Pathogenesis Pathology Microbiology Clinicalpresentation Makingthediagnosis Management Antimicrobialprophylaxis:(2007AHAguidelines) References ARF RheumaticFever(ARF) Pathology Clinicalpresentation Makingthediagnosis MajorCriteria: MinorCriteria: ManagementPrinciples: Generaltreatmentoftheacuteepisode: Cardiacmanagement: Prevention QuickChecks-KawasakiDisease,Endocarditis,Rheumaticfever Prev Next   Page4of20 HeartMurmurs SystolicMurmurGradesbasedontheintensityofthemurmur SummaryofHeartMurmers Systolic Diastolic Continuous AboutthisbookChapterIndex HeartMurmurs Murmursareadditionalsoundsgeneratedbyturbulentbloodflowintheheartandbloodvessels.Murmursmaybesystolic,diastolicorcontinuous. SystolicMurmurGradesbasedontheintensityofthemurmur I/VI:Barelyaudible II/VI:Faintbuteasilyaudible III/VI:Loudmurmurwithoutapalpablethrill IV/VI:Loudmurmurwithapalpablethrill V/VI:Veryloudmurmurheardwithstethoscopelightlyonchest VI/VI:Veryloudmurmurthatcanbeheardwithoutastethoscope Systolicmurmursarethemostcommontypesofmurmursinchildrenandbasedontheirtimingwithinsystole,theyareclassifiedinto: a)Systolicejectionmurmurs(SEM,crescendo-decrescendo)resultfromturbulentbloodflowduetoobstruction(actualorrelative)acrossthesemilunarvalves,outflowtractsorarteries.ThemurmurisheardshortlyafterS1(pulse). Theintensityofthemurmurincreasesasmorebloodflowsacrossanobstructionandthendecreases(crescendo-decrescendoordiamondshaped).InnocentmurmursarethemostcommoncauseofSEM(seebelow).Othercausesincludestenoticlesions(aorticandpulmonarystenosis,coarctationoftheaorta,tetralogyofFallot)orrelativepulmonarystenosisduetoincreasedflowfromanASD     Crescendodecrescendomurmur b)Holosystolic(regurgitant)murmursstartatthebeginningofS1(pulse)andcontinuetoS2.Examples:ventricularseptaldefect(VSD),mitralandtricuspidvalveregurgitation.    Holosystolicmumur c)DecrescendosystolicmurmurisasubtypeofholosystolicmurmurthatmaybeheardinpatientswithsmallVSDs.Inthelatterpartofsystole,thesmallVSDmaycloseorbecomesosmalltonotallowdiscernibleflowthroughandthemurmurisnolongeraudible.   Decrescendomurmur Diastolicmurmursareusuallyabnormal,andmaybeearly,midorlatediastolic. Moreinformation:Examplesofinnocentmurmu Stillsmurmur Pulmonaryflowmurmur Peripheralpulmonarystenosis(PPS) Venoushum   EarlydiastolicmurmursimmediatelyfollowS2.Examples:aorticandpulmonaryregurgitation. Mid-diastolicmurmurs(rumble)areduetoincreasedflow(relativestenosis)throughthemitral(VSD)orthetricuspidvalves(ASD). LatediastolicmurmursareduetopathologicalnarrowingoftheAVvalves.Example:rheumaticmitralstenosis.Tricuspidstenosisisveryrareinchildren. Continuousmurmursareheardduringbothsystoleanddiastole.Theyoccurwhenthereisaconstantshuntbetweenahighandlowpressurebloodvessel.Examples:patentductusarteriosus(PDA)andsystemicarterio-venousfistulas.ThismayalsooccurinsurgicallyplacedshuntssuchasaBTshuntbetweentheaortaandthepulmonaryartery. Innocentmurmursarecommoninchildrenandhavethefollowingcharacteristics: GradeIIIorlessinintensity Anotherwiseanormalcardiacexaminationandnormalheartsounds Noassociatedcardiacsymptoms Changeinintensitywithbodyposition(e.g.louderinsupineposition) SummaryofHeartMurmers  Tableshowingthecommonsystolic,diastolicandcontinuousheartmurmurs Systolic SEM:Innocentmurmurs,obstructivelesions*,ASD Holosystolic:VSD,MR,TR(mitralandtricuspidinsufficiency) Decrescendo:usuallywithsmallVSDs(asVSDalmostclosesbytheendofsystole  Diastolic Early:AI,PI(aorticandpulmonaryinsufficiency) Mid:relativemitralstenosis(VSD)orrelativetricuspidstenosis(ASD) Late:RheumaticMS(mitralstenosis)  Continuous Usuallyvascularinoriginwhenahigh-pressurevesselcommunicateswithalow-pressurevessele.g.PDA(beyondtheneonatalperiod),BTshunt,AVmalformationanywhereinthebody(heart,lungs,brain,liverorpregnantuterus) *ObstructivelesionsincludeAS,PS,Coarctationoftheaorta,TOF,etc.     Tableshowingthecommonheartmurmursaudibleatdifferentage Immediatelyafterbirth PDAorobstructivelesions* Shortlyafterbirth(afewhourstofewweeks) VSD,PDA,PPS(peripheralpulmonarystenosis) 1-4years Innocentmurmurs,ASD Teenage Innocentmurmur,HOCMorMVP/MR *ObstructivelesionsincludeAS,PS,Coarctationoftheaorta,TOF,etc     toc|returntotop|previouspage|nextpage Content©2017.SomeRightsReserved. Datelastmodified:July7,2017. AshrafAlyandSohamDusgupta Dept.ofPediatrics UniversityofTexasMedicalBranch.