Murmurs

Dr. Kalpana MallaMBBS MD (Pediatrics) Manipal Teaching Hospital

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Classification of CVS anomaly1. Structural heart defects-cyanotic, acyanotic 2. Functional heart defects cong cardiac arrythmias 3. Positional heart defects - dextrocardia

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

Types1. Innocent or functional 2. Pathological or organic

INNOCENT MURMURS:k

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Also known as flow, benign, non pathologic, functional, inorganic physiologic Occur in up to - 77% of neonates - 66% of children - 90% with exercise

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

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

Pathologic murmurs Associated with structural abnormalities of CVS Characteristics: Grade 3 or louder Thrill + Pansystolic ,diastolic Abnormal pulse Cardiac symptoms Abnormal ECG,CXR

Systolic Murmurs1. Holosystolic /Pansystolic - MR- TR - VSD

Systolic Murmurs2. Ejection systolic (Midsystolic)

- Innocent M - Flow M all flow M in VSD,ASD,PDA- Aortic valve sclerosis - Aortic outflow obstruction - Aortic stenosis 3. Late systolic M - MV prolapse - TV prolapse

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

Diastolic murmurs Late Diastolic M ( Presystolic M) - MS - TS

Continuous Murmurs PDA Aorticopulmonary window Arteriovenous fistulas Venous hum

Nada s criteria:MAJOR 1.Systolic murmur grade>3 2.Diastolic murmur 3.Cyanosis 4.CCF MINOR 1.Systolic murmur L side Radiation may go to LMSB Intensity grade I-III Pitch mid to low Character continuous ,soft, whispering, roaring, or blowing

Venous Humk k

Variation Disappears - supine position, - with gentle manual compression of jugular vein - with head turn AWAY from the side

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