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Innocent Heart Murmur: 6 Grades of Heart Murmurs
Innocent Heart Murmur: 6 Grades of Heart Murmurs
1st heart sound TIM due to closure of tricuspid and mitral valve
I = insufficiency
TIM insufficiency = systolic murmur heard
2nd heart sound SAP due to closure to aortic and pulmonary valve
S = stenotic aortic/pulmonary valve murmur is always systolic
Most common arrhythmia treated in children Supraventricular tachycardia (HR > 250)
After 1 yrs old, if heart size is > 50% of thoracic ratio cardiomegaly
A = Acidosis
T = Temperature ↑sed temperature (fever) ↑sed cyanosis
R = Ratio of adult: fetal Hb (↑er fetal Hb = more oxygen)
3 types of ASD:
a) Mostly from ostium secundum usually from persistent foramen ovale
foramen ovale closes at 2-3 months in 80%
foramen ovale persists becomes ASD
b) Ostium primum
c) Endocardial cushion defect common in Down syndrome
Holt–Oram syndrome
Atrial septal defect + skeletal abnormalities in upper extremities
Autosomal dominant disorder that affects bones in the arms and hands (the upper limbs)
May also cause heart problems
PDA
Newborn Systolic murmur heard in left upper sternal border
Most common congenital heart disease in premature babies
Murmur in left upper sternal border of newborns PDA unless proven otherwise
Indomethacin, Motrin closes PDA (avoid motrin in pregnant mothers facilitates closure of PDA)
Prostaglandin keeps ductus opened
Can also occur in full term babies
PDA: 1st systolic murmur then becomes to and fro/continuous machinery like murmur
Wide pulse pressure = systolic murmur = PDA
Norwood operation to treat
PDA life saving defect for hypoplastic heart syndrome patients
PDA life long risk of endocarditis (prophylaxis amoxicillin)
VSD
Most common congenital heart disease in children
Eisenmenger’s syndrome from VSD
Holosystolic murmur + thrill VSD unless proven otherwise
Amoxicillin 250mg 6hrs before surgery and 6hrs after surgery prevents endocarditis and Strep. viridans 2
kinds:
a) Membranous 75%
b) Muscular 25%, closes spontaneously (holosystolic murmur that “disappears” due to VSD closure)
Coarctation of Aorta
More common in males
Female + coarctation of aorta + webbed neck Turner’s syndrome
Normal: Leg pressure 10mmHg higher than arm (reversed in coarctation of aorta)
Most common congential heart disease in kids with HTN
CXR Rib notching, figure of 3
Aortic Stenosis
Systolic murmur heard
Left ventricular hypertrophy
Right upper sternal border murmur that radiates to neck
Thrill
Pre-systolic click
Pulmonary Stenosis
Systolic murmur heard
Right ventricle involved
Right ventricular hypertrophy
Right sided heart enlarged
↓sed pulmonary vascularity
Left upper sternal border murmur that radiates to the back Pre-systolic click 3 types:
Mild no treatment, just follow up in cardiology clinic 1x every 6 months,
Moderate
Severe
TOF
Young baby crying cyanotic/tet spells
Prevent crying Give oxygen, shot of morphine, flex hip
Usual cause of death in TOF Brain abscess or stroke
Older kids like to squat (to ↑se systemic pressure), finger clubbing, AA pts: examine oral mucosal membrane
CXR boot-shaped heart (from ↑sed pulmonary vascularity)
2 conditions that give right aortic arch TOF, truncus arteriosus
Must have VSD to survive
Associated with DiGeorge syndrome 4 components:
a) Right ventricular hypertrophy
b) Transposition of great vessels
c) VSD
d) Overriding of aorta
Tricuspid Atresia
Absent tricuspid valve
Right ventricular hypoplasia
Right atrium enlargement
Associated with Ebstein anomaly
• Mothers on depression meds/lithium tricuspid atresia
• -Parkinson-White syndrome
• Tricuspid valve moves downward towards right ventricular apex tricuspid valve
regurgitation (holsystolic murmur)
Endocarditis
Risk factors: valve defect/replacement, history of endocarditis,
untreated cyanotic heart disease, heart transplant
Most common organism Strep.viridans (for pts with congenital heart
disease) Staph.aureus (for pts WITHOUT congenital heart disease) 2
criteria to diagnose endocarditis:
Blood culture organisms
Echocardiogram valve lesions
Rheumatic Endocarditis Most common acquired heart disease in children ABOVE AGE 5
Sore throat
Tonsilitis
Hemolytic ß-Strep Group A
Antibiotic to treat
Heart murmur from mitral insufficiency
Mitral valve involvement
Treatment: oral penicillin, erythromycin for penicillin allergic pts
Lifelong prophylaxis
CHF death
Untreated Strep. Throat in kids rheumatic endocarditis
ACESS
A = Arthritis
C = Carditis
E = Erythema marginatum
S = Subcutaneous nodules
S = Sydenham chorea
Sinus Bradycardia
HR < 60 in children
HR < 20 in infants
2nd Degree AV Block 2 types: Mobitz Type I PR interval prolongation, dropped beat
Mobitz Type II no PR prolongation, dropped beat
Atrial Fibrillation
Older patients
Complications: Emboli