What are features of an innocent murmur?
Soft, systolic, short, no radiation, normal pulses, asymptomatic child
What does “Still’s murmur” sound like?
Vibratory or musical systolic murmur
Where is Still’s murmur best heard?
Left lower sternal edge
When are innocent murmurs louder?
Fever, anaemia, exercise
Effect of position on innocent murmurs?
Often decrease/disappear on standing
What features suggest a pathological murmur?
Loud, diastolic, pansystolic, harsh, with radiation, abnormal exam
Why are diastolic murmurs always abnormal?
They indicate pathological flow
What associated features suggest pathology?
Cyanosis, failure to thrive, tachypnoea, hepatomegaly
What pulse abnormalities suggest pathology?
Weak, bounding, or radio-femoral delay
What is a systolic murmur?
Occurs between S1 and S2
What is a diastolic murmur?
Occurs after S2 before next S1
What is a pansystolic murmur?
Heard throughout systole
Which lesions cause pansystolic murmurs?
VSD, mitral regurgitation, tricuspid regurgitation
Murmur of VSD?
Harsh pansystolic murmur at left lower sternal edge
Why is small VSD louder?
More turbulence through smaller defect
Murmur in ASD?
Ejection systolic murmur + fixed split S2
Why murmur occurs in ASD?
Increased flow across pulmonary valve (not the defect itself)
Murmur of PDA?
Continuous “machinery” murmur
Where is PDA murmur best heard?
Left infraclavicular area
Murmur in TOF?
Ejection systolic murmur (pulmonary stenosis)
Key associated feature TOF?
Cyanosis
Murmur in coarctation?
Systolic murmur over back
Key clinical clue CoA?
Radio-femoral delay
Effect of standing on innocent murmurs?
Decreases intensity
