PEARL Oct 2nd
What are the features of innocent vs pathologic heart murmurs in children? What are the following murmurs, and what are their causes: Still’s murmur, physiologic systolic ejection murmur, supraclavicular arterial bruit, neonatal peripheral stenosis, cervical venous hum, and mammary soufflé?
Features of innocent heart murmurs:
>50% of children have benign murmurs. They are due to turbulent flow at the origin of the great vessels. They are better heard in children than adults because:
–Thin chest wall in children
–More angulated great vessels in children
–More dynamic circulation in children
Types of innocent murmurs:
Due to blood flow across aortic valve. Heard best over RUSB and is a systolic ejection murmur (vibratory and musical in quality). It is seen in infancy to adolescence.
Physiologic systolic ejection murmur:
Second most common. Heard best at mid to upper sternal border. Heard best with diaphragm due to frequency.
Supraclavicular arterial bruit:
Above and NOT below the clavicle. Louder on the right due to brachiocephalic arteries branching.
Neonatal peripheral pulmonary stenosis (PPS):
Birth to 3-6 months. Heard best at base, both axillae, and back. Due to relative small size of branch pulmonary arteries and angle of bifurcation of the PAs.
Cervical venous hum:
Continuous hum. Heard over RUSB. Better in sitting, disappears in supine position and when pressure is applied to neck to reduce venous blood return
Noted in lactating mothers, due to increased mammary blood flow.
FEATURES OF PATHOLOGIC MURMURS:
– All diastolic murmurs
– All pansystolic murmurs
– Late systolic murmurs
– Loud murmurs (>3/6)
– Continuous murmurs
– Associated cardiac abnormalities
– How to distinguish between innocent and pathologic heart murmurs in children. Rosenthal, A. The pediatric clinics of North America, Dec 1984, page 129
– Innocent murmurs. Newburger, JW. Pediatric Cardiology, page 281