Heart murmurs in children - GP CME
Transcript of Heart murmurs in children - GP CME
Heart murmurs in children
Clare O’Donnell
Paediatric/Adult Congenital Cardiologist
Greenlane Paediatric and Congenital Cardiac Service
Murmurs in childhood are:
Common
Usually innocent
Innocent heart murmurs
Prevalence ? 40-60% after infancy
Findings– normal heart sounds
– soft
– systolic (except venous hum)
– usually brief
– localised
– change intensity with position
– otherwise WELL - normal exam and history
When to worry/refer
• Failure to thrive/poor feeding
• Breathlessness/Fatigue
• Cyanosis
• Not soft/systolic
• Family History
Increased risk
• Sibling or parent with CHD
• Associated chromosomal condition
• Associated congenital abnormality
– eg diaphragmatic hernia
• Diabetic Mother
Congenital Heart Disease
Approximately 1/100 children
Neonates
– Blue
– Breathless
– Poorly perfused
Duct important for either pulmonary supply or aortic supply
Post neonatal presentation
• Murmur
• Blue Spells
• Poor growth
• Chest infections
• Fast heart rate
• (stridor, wheeze, choking)
Common stuff
• VSD 35 % (remember small hole – BIG noise)• ASD 10%• PDA 7%• Pulmonary stenosis 7%• Aortic stenosis 4%• Coarctation 4%• Tetralogy 4%
All cyanotic 14%
Percent of total CHD in liveborn infants
Tips on exam
• Failure to thrive
• Breathlessness
• Murmur – listen broadly and on back
• Femoral pulses!
Coarctation – a good problem to find
Murmur – front of chest but particularly posteriorly
• Diminished or absent femoral pulses
• Hypertension Right arm
Cyanosis – difficult clinical sign
Detectable clinically ? 80-85%
– Oximeter
• Remember acrocyanosis - blue peripheries
Pulse oximetry screening
Rheumatic heart disease
Most commonly Mitral regurgitation and Aortic regurgitation
NZ guidelines
The classical innocent murmurs in children
Vibratory murmur
Still’s murmur
“a twanging sound, very like that made by twanging a piece of
tense string” George F Still 1909
Aortic leaflet vibration
almost disappears with sitting
Venous hum
continuous murmuraccentuated in diastole
varies with posture, head movement
A few thoughts re tests
If you can’t examine the child tests may be difficult….
ECGs in children
Echocardiogram
Congenital heart disease assessment ‘structural’ vs adult ’functional’ assessment
What about antenatal scans in children?
What do they miss?
• Limitations to views
• Varying degrees of experience
• Assessment may be based on four chamber view
Our standard approach to triage
To finish
• Murmurs are common
• Significant Congenital Heart disease is not
• Watch for ‘clues’ – failure to thrive, frequent chest infections
• Check femoral pulses
• Watch for rheumatic heart disease in susceptible populations
Thank you