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HEART MURMURS

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  1. 50-80% of children have audible heart murmurs at some point in their lives 
  2. most murmurs are functional (i.e. "innocent") without associated
    structural abnormalities
  3. murmurs can become audible or accentuated in high output states,
    e.g. fever
Differentiating Innocent and Pathological Heart Murmurs
     

    Innocent

    Pathological

    history and

    physical

    asymptomatic

    symptoms and signs of cardiac disease

    timing

    systolic ejection murmur (except venous hum)

    all diastolic, pansystolic or continuous

    grade

    <2/6

    >2/6

    splitting

    physiologic S2

    fixed splitting or single S2

    extra sounds clicks

    none

    present

    change of position

    murmur varies

    unchanged

     

     

    Five Innocent Heart Murmurs

    Type

    Description

    Differential Diagnosis

    1.Still's murmur

    vibratory, LLSB or apex

    subaortic stenosis, small VSD

    2.pulmonary ejection

    soft, blowing, ULSB

    ASD, PS

    3.venous hum

    infraclavicular hum, continuous, R > L

    PDA

    4.supraclavicular arterial bruit

    low intensity, above clavicles

    AS, bicuspid aortic valve

    5.peripheral pulmonic stenosis

    neonates, low-pitched radiates to axilla and back

    PDA, PS

    HEART MURMURS HEART MURMURS Reviewed by Radiology Madeeasy on August 28, 2010 Rating: 5
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