Level 2 - CVD

Question 1

What is an innocent murmur?

Answer 1

• Parasternal low-frequency ‘twangs’ in early systole

Question 2

What is Still’s murmur?

Answer 2

Mid-left sternal border, mid-systolic grade 2-3, muscial vibratory sound

Question 3

What is pulmonary flow murmur?

Answer 3

Upper left sternal border, mid-systolic, grade 1-2, grating

Question 4

What is venous hum?

Answer 4

Right and/or left infraclavicular continuous, heard in upright position, diastolic compenent louder than systolic

Question 5

What is a carotid bruit?

Answer 5

Supraclavicular area, ejection systolic, grade 2-3

Question 6

What is peripheral pulmonary stenosis? (pulmonary flow murmur of newborn)

Answer 6

Upper left sternal border, grade 1-2, radiates to axillae and back, usually disappears by 6 months

Question 7

Epidemiology of innocent murmur?

Answer 7

• 80% of children have innocent murmur at some point in time

Question 8

Risk Factors of innocent murmur?

Answer 8

o Fever

o Anaemia

o Anxiety

o Exercise

Question 9

What are innocent murmurs due to?

Answer 9

• Due to increased cardiac output

Question 10

Symptoms of innocent murmurs?

Answer 10

• Innocent murmur (4 S’s)

o Asymptomatic patient

o Soft blowing murmur

o Systolic murmur

o Left Sternal edge

o Sensitive (changes with child’s position)

Question 11

What signs in innocent murmurs?

Answer 11

• Normal heart sounds, no parasternal thrill, no radiation
• No clubbing, cyanosis, rib recession, arrhythmias, normal pulses

Question 12

DDx of innocent murmur?

Answer 12

• Pathological murmur – congenital heart defects

Question 13

Investigations in innocent murmur?

Answer 13

Usually none

• If pathological suspected:

o Echocardiogram gold standard

o Chest X-ray and ECG may mislead

Question 14

Management of innocent murmur?

Answer 14

• Once a heart murmur is confirmed to be innocent, reassurance to the family regarding its benign nature is important
• Although the murmur may never disappear and may persist into adulthood, the parent and child need to be specifically reassured that an innocent murmur is simply an additional noise audible to the clinician