Incidental Detection of cardiac murmurs 20022021 GPSTP 1

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Incidental Detection of cardiac murmurs 20/02/2021 GPSTP 1

Incidental Detection of cardiac murmurs 20/02/2021 GPSTP 1

Pre-Antenatal Scan Era -----------------Post Antenatal Scan Era 20/02/2021 GPSTP 2

Pre-Antenatal Scan Era -----------------Post Antenatal Scan Era 20/02/2021 GPSTP 2

Timing of Presentation Percentage of Incidence 45 40 35 30 25 Mild 20 Moderate

Timing of Presentation Percentage of Incidence 45 40 35 30 25 Mild 20 Moderate 15 Major 10 Critical 5 0 Antenatal 20/02/2021 1 2 Age (years) GPSTP 3 4 3

Innocent Murmurs • Term coined by William Evans in 1947 • More than >50%

Innocent Murmurs • Term coined by William Evans in 1947 • More than >50% of all children have innocent heart murmurs • Common age: 3 to 6 years • Thin chest wall in children • More angulated great vessels in children • More dynamic circulation in children 20/02/2021 GPSTP 4

Pathological murmurs • • All diastolic murmurs Can be associated with thrill Radiates All

Pathological murmurs • • All diastolic murmurs Can be associated with thrill Radiates All pansystolic murmurs Late systolic murmurs Loud murmurs > 3/6 Continuous murmurs (except venous hum) Associated cardiac abnormalities 20/02/2021 GPSTP 5

Innocent Heart Murmurs • • • Still’s murmur: Origin: Left Ventricular outflow Heard best

Innocent Heart Murmurs • • • Still’s murmur: Origin: Left Ventricular outflow Heard best left parasternal and aortic area systolic ejection murmur, vibratory, musical in quality. Seen in infancy to adolescence DD: VSD, Aortic stenosis, Pulmonary stenosis Best heard in Supine Pulmonary Flow Murmur Second most common. Hear best at the left mid to upper sternal border. Commonly heard when child is unwell No radiation DD: PS, ASD 20/02/2021 GPSTP 6

Innocent Heart Murmurs • • • Supraclavicular arterial bruit: Above the right clavicle. Brachiocephalic

Innocent Heart Murmurs • • • Supraclavicular arterial bruit: Above the right clavicle. Brachiocephalic arteries branching Neonatal peripheral pulmonary stenosis (PPS): Birth to 3 -6 months. Heard best at base of the heart, both axillae and the back. Due to relative small size of branch pulmonary arteries and the angle of bifurcation of the Pas DD: PS, ASD Cervical venous hum; Continuous hum. Heard in the right infraclavicular area Better in sitting, disappear in supine and when pressure is applied to neck to reduce venous blood return. 20/02/2021 GPSTP 7

Management • Don’t diagnose innocent heart murmurs in infancy! • Check Saturations ≥ 99%

Management • Don’t diagnose innocent heart murmurs in infancy! • Check Saturations ≥ 99% • Review the child later well • Ensure that child is asymptomatic • CXR/ECG rarely useful • Echocardiogram: Gold standard 20/02/2021 GPSTP 8

MODEL ATOM 20022021 1 20022021 2 E0 nMODEL ATOM 20022021 1 20022021 2 E0 n
Chapter 9 Incidental Forgetting 2 Forgetting Incidental ForgettingChapter 9 Incidental Forgetting 2 Forgetting Incidental Forgetting
The incidental user Customers as incidental users ofThe incidental user Customers as incidental users of
DYNAMIC AUSCULTATION FOR CARDIAC MURMURS Dr Benny JDYNAMIC AUSCULTATION FOR CARDIAC MURMURS Dr Benny J
CARDIAC MURMURS DR NIYAS K NASEER DM RESIDENTCARDIAC MURMURS DR NIYAS K NASEER DM RESIDENT
Cardiac Murmurs Lubna Piracha D O Assistant ProfessorCardiac Murmurs Lubna Piracha D O Assistant Professor
CARDIAC MURMURS DR NIYAS K NASEER DM RESIDENTCARDIAC MURMURS DR NIYAS K NASEER DM RESIDENT