Innocent Heart Murmurs - sha

Transcription

Innocent Heart Murmurs
Mansour Al-Mutairi MD
Consultant Pediatric cardiologist
King Abdulaziz Cardiac Center
Assistant Professor, Cardiac Sciences
KSAU-HS, NGHA
Riyadh , Saudi Arabia
Misconceptions
Patient with Heart
Murmur
Innocent Heart Murmur
Characteristic’s of Innocent Murmur:
Characteristic’s of Pathological Murmur:
Classification of innocent murmur:
• Four systolic innocent murmurs:
o Still’s murmur or vibratory systolic murmur
o Physiological or functional pulmonary flow murmur.
o Peripheral Pulmonary arterial stenosis murmur of
the newborn.
o Aortic systolic murmur.
• One continuous innocent murmurs:
o Venous hum.
Still’s Vibratory Systolic Murmur:
• Most common , described by George F. Stills in 1909 as
“A twanging sound”
• Peak incidence in children 3 to 7 years, disappears at
puberty
• Musical, vibratory, low to medium in pitch, early
systolic ejection murmur.
• Maximum at LLSB and extending to apex, loudest in
supine position and change in character with upright
position but seldom disappear.
• Turbulence produced by the physiological narrowing of
the LV outflow tract.
• Highly associated with false tendons (16.8%).
Physiological or functional pulmonary flow
Murmur:
• Early systolic, crescendo-decrescendo, grade II-III
at LUSB.
• Best heard in supine position (↑ by pectus
excavatum).
• Decreases during upright position and held
inspiration.
• Turbulent flow at the origin of the RT & LT
pulmonary arteries
• DDx the murmur of ASD-II.
Peripheral Pulmonary Stenosis of the
Newborn:
• Short early to mid-systolic ejection murmur of medium
pitch & intensity at the axillae and back.
• Heard in newborns and infants less than 1 year.
• Result from the turbulence in the PA’s.
• It increase with ↓ heart rate.
• DDx is PPS, ASD-II.
Aortic Systolic Murmur:
• Short, low to medium pitch.
• Arise from the outflow tract in older children and
adults.
• Audible maximally in the aortic area.
• DDx from the systolic murmur of the HCM
especially with history of sudden death or +ve FH
or if increase with Valsalva maneuver.
Venous Hum:
•
•
•
•
•
•
•
•
The most common type of continuous innocent murmurs.
The diastolic component is louder.
Whining, intensity varies.
Increased when child sitting / standing ,neck extended and
looking away from the examiner.
Disappear with lying down and occluding neck veins with
fingers.
Louder at high right sternal border and infraclavicular area
however sometimes maximum on the left or equal in intensity
bilaterally.
Result form turbulent blood flow at the junction between JV
and the SVC.
DDx PDA.
Neonatal screening exam:
Neonate and young infant
Older child
Variable murmur ( Yes & no !)
FH:
Hereditary disease, CHD, RF, sudden death.
Pregnancy :
Infections, medications, smoking or alcohol intake.
Postnatal:
Birth weight, weight gain, feeding pattern, cyanosis, squatting,
S.O.B, tachypnea, chest infections, exercise intolerance, chest
pain, joint pain and neurologic symptoms.
Clinical examination:
Inspection:
General appearance, nutritional status, dysmorphism, syndromes,
clubbing and signs of RD.
Palpation:
(rate, regularity, volume, delay),
(proper cuff), apical
impulse and PMI , hyperactive precordium and thrills.
Auscultation:
Heart sound and
Others:
Abdominal examination.
.
Complete heart block
The Role of the Pediatrician Today
The Role of the Pediatric Cardiologist

Innocent Heart Murmurs - sha

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