What are the key features of innocent murmurs in children?
Seven S’s
- Sensitive (changes w/position or respiration)
- Short duration
- Single
- Small
- Soft
- Sweet
- Systolic
If a murmur is present at birth, what should it be considered?
A valvular problem until proven otherwise
Heart murmurs in newborns?
- Common in first days of life and do NOT usually signify structural heart problems
- If murmur goes away before 24 hrs of life, infant can be discharged with FU auscultation in 2-3 days
Define transitional neonatal murmurs
- Soft (grade 1-3/6)
- Heard at left upper to midsternal border
- Infant is pink, well-perfused, no resp distress
Signs of coarctaction of aorta in newborn?
- Murmur persists beyond 24 hrs of age
- BP in right arm and a leg shows a difference over 15
- Difficult to palpate LE pulses
What is recommended in newborns to identify congenital heart disease?
Predischarge pulse ox screening
Describe Still’s murmur
- Low frequency
- Systolic
- 3/6 intensity or less
- LSB
Describe pulmonic flow murmur
- Mid frequency
- 3/6 intensity or less
- Left upper sternal border
Describe venous hum
- High frequency
- 3/6 intensity or less
- Sitting or standing, base of neck or supra/infraclavicular areas
- Abolished by compression of jugular vein, change of head position, or assumption of supine position
Describe carotid bruit
- Heard over carotid artery
- 3/6 intensity or less
Which murmur in newborns is low frequency and best heard at LSB?
Still’s murmur
Which murmur in newborns is mid frequency and best heard at left upper sternal border?
Pulmonic flow murmur
Which murmur in newborns is high frequency and best heard in sitting or standing position?
Venous hum
How does atrial septal defect present?
- Frequently asymptomatic
- Fixed, widely split S2
- Grade 1-3/6 systolic ejection murmur at pulmonary area
How does ventricular septal defect present?
- FTT, tachypnea, diaphoresis
- Holosystolic murmur at lower left sternal border
How does AV canal/septal defect present?
- Murmur often INAUDIBLE
- Common in infants with Down Syndrome
How does PDA present?
- Continuous machinery murmur
- Bounding peripheral pulses (if large ductus present)
- FTT, tachypnea, diaphoresis
How does pulmonary valve stenosis present?
- Mild/mod: NO symptoms
- Ductal dependent: cyanosis and right heart failure
- RV lift
- Dilated pulmonary artery on CXR
What may present identical to pulmonary valve stenosis?
Subvalvular or supravalvular pulmonary stenosis
How does peripheral (branch) pulmonary artery stenosis present?
- Systolic murmurs may be heard over both lung fields anterior and posterior, radiating to axilla
- Mild, nonpathologic stenosis produces a murmur in infancy that resolves by 6 months old
What type of stenosis produces a murmur in infancy that resolves by 6 months old?
Mild, nonpathologic peripheral (branch) pulmonary artery stenosis
How does aortic stenosis present?
- Harsh systolic ejection
- Systolic click at apex
- Dilation of ascending aorta on CXR
How does mitral valve prolapse present?
- Midsystolic click
- Often overdiagnosed on routine cardiac US
Which heart condition is often overdiagnosed in neonates on routine cardiac US?
Mitral valve prolapse
