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  1. 1. Murmurs Dr. Kalpana Malla MBBS MD (Pediatrics) Manipal Teaching HospitalDownload more documents and slide shows on The Medical Post [ ]
  2. 2. Classification of CVS anomaly1. Structural heart defects-cyanotic, acyanotic2. Functional heart defects – cong cardiac arrythmias3. Positional heart defects - dextrocardia
  3. 3. Murmurs• Turbulence in blood flow at or near valve - flow murmur• An abnormal communication within heart – shunt murmur• Heart murmurs may be present without any heart disease
  4. 4. Types1. Innocent or functional2. Pathological or organic
  5. 5. INNOCENT MURMURS:Also known as flow, benign, non pathologic,functional, inorganic physiologicOccur in up to - 77% of neonates - 66% of children - 90% with exercise
  6. 6. What are Innocent Murmurs?- Due to physiological turbulence of blood within normal anatomical heart- No structural cardiac Ds- No hemodynamic abnormalities- Become prominent – fever, anxiety, anemia, infections
  7. 7. Character of IM• Systolic soft grade 2 ** exception venous hum – continuous murmur• No thrill• Intensity variable – change with posture• Normal pulse• Normal S2• Normal CXR & ECG
  8. 8. Pathologic murmurs• Associated with structural abnormalities of CVS• Characteristics:• Grade 3 or louder• Thrill +• Pansystolic ,diastolic• Abnormal pulse• Cardiac symptoms• Abnormal ECG,CXR
  9. 9. Systolic Murmurs1. Holosystolic /Pansystolic - MR - TR - VSD
  10. 10. Systolic Murmurs2. Ejection systolic (Midsystolic) - Innocent M - Flow M – all flow M in VSD,ASD,PDA - Aortic valve sclerosis - Aortic outflow obstruction - Aortic stenosis3. Late systolic M - MV prolapse - TV prolapse
  11. 11. Diastolic murmurs• Early diastolic M - Aortic Regurgitation - Pulmonary R• Mid – Diastolic M – MS – TS – Artial myxoma – ↑ flow across AV valve – Austin Flint M – Carey- Coombs M
  12. 12. Diastolic murmurs• Late Diastolic M ( Presystolic M) - MS - TS
  13. 13. Continuous Murmurs– PDA– Aorticopulmonary window– Arteriovenous fistulas– Venous hum
  14. 14. Nada’s criteria:MAJOR MINOR1.Systolic murmur 1.Systolic murmur<3 grade>32.Diastolic murmur 2.Abnormal S23.Cyanosis 3.Abnormal ECG4.CCF 4.Abnormal x-ray 5.Abnormal BP
  15. 15. Diagnosis:• Presence of 1 major OR 2 minor criteria• Nada’s criteria for presence of heart disease
  16. 16. Innocent Murmurs of Childhood1. Vibratory Still′s murmur2. Pulmonary flow murmur3. Physiological pulmonary flow murmur of neonate4. Carotid bruit5. Venous hum6. Apical murmur
  17. 17. Vibratory Still’s MurmurMost common innocent murmur ofchildhoodAge — 2 to 6 years, rare in teensEtiology—unknown, may be associatedwith LV ejection
  18. 18. Still’s MurmurLocation—max at LLSB, LMSBCharacter—vibratory, groaning, musicalRadiation— apex,Timing—mid-systoleIntensity—grade I-IIPitch—mid to low
  19. 19. Still’s Murmur ……Variation—Loudest - supine, after exercise, withfever, anemia, or excitementDisappears or localizes to LLSB when uprightNormal ECG
  20. 20. 2. Pulmonary Systolic Murmur:Age — common 8-14 yearsEtiology—normal ejection vibrations,turbulence through PVIntensity— mid systolic grade I-IIILocation - ULSBPitch—mid to high-pitchedCharacter—soft, blowing, somewhatgrating, diamond-shaped
  21. 21. Pulmonary Systolic MurmurVariation—louder when supine, fever, -exercise, anemiaD/DASDPSSub ASToF
  22. 22. Physiological Pulmonary flow murmur of neonateAge —newborns. May last 3 – 6 monthsEtiology— turbulence and relativeobstruction at PA bifurcation due to acuteangle at birth
  23. 23. Physiological Pulmonary flow murmur of neonateLocation—LUSBRadiation—LMSB, bilateral axillae, mid-backTiming—early to mid-systole
  24. 24. Physiologic PPSIntensity—grade I-IIPitch—high-pitchedCharacter—blowing, not harsh, diamond-shapedVariation—none
  25. 25. 4. Carotid Bruit• Bruit is French for “noise”• Age range—children and young adults• Etiology— turbulence at take off of carotid or brachiocephalic vessels
  26. 26. Carotid Bruit (Characteristics):Location—neck - suprasternalnotch, supraclavicular areasRadiation—carotids, below claviclesTiming—early to mid-systole (grade I-III)Character—may be slightly harshArise in carotid or subclavian arteries
  27. 27. Carotid BruitVariation—decreased intensity withhyperextension of shoulders; louder withanxiety, anemia,D/DSupravalvar or valvar ASCoABicuspid AoV
  28. 28. 5. Venous Hum:Second most common innocent murmurEtiology—turbulence in jugular and subclavianvenous return meeting in SVCAge - pre-schoolAdololescents - can be + w/ increased bloodflow states e.g. anemia, pregnancy,thyrotoxicosis
  29. 29. Venous HumLocation—anterior neck to mid-infraclaviculararea, R side > L sideRadiation—may go to LMSBIntensity—grade I-IIIPitch—mid to lowCharacter— continuous ,soft, whispering,roaring, or blowing
  30. 30. Venous HumVariation—Disappears - supine position, - with gentle manual compression of jugular vein - with head turn AWAY from the side
  31. 31. Thank youDownload more documents and slide shows on The Medical Post [ ]