Benign paediatric heart murmur
From Wikipedia, the free encyclopedia
A benign paediatric heart murmur, also innocent heart murmur or innocent murmur, is an inconsequential sound that originate from the heart and/or cardiovascular system and is heard on cardiac auscultation. By definition, an innocent murmur is not significant in the long-term health of an individual that has it.
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[edit] Characteristics
- Soft, less than 3/6 in intensity (although note that even when structural heart disease is present, intensity does not predict severity.)
- Often position-dependent (Murmurs heard while upright or sitting may disappear when lying supine.)
- Otherwise healthy individual, no concerns about growth, no symptoms of heart failure such as dyspnea on exertion. (In infants, ask if the baby tires during feeding, becomes diaphoretic, or develops a rapid respiratory rate. In older children, this can be elucidated by asking whether or not the child can keep up with peers during play.)
- Occurs during systole or continuously during both systole and diastole. (Murmurs occurring only during diastole are always pathologic.)
- Physiologic splitting of S2 (A2 and P2 components should only be resolvable during inspiration and should merge during expiration.)
- No palpable thrill (A thrill is a vibration caused by turbulent blood flow.)
[edit] Prognosis
Innocent murmurs are inconsequential and usually disappear as the child grows. ECG and Chest XRAY are normal.
[edit] Types, description and DDx
| Name | Location | DDx |
|---|---|---|
| Still's murmur | inferior aspect of LLSB, systolic ejection sound, vibratory/musical quality | subaortic stenosis, small VSD |
| Pulmonary ejection | superior aspect of LLSB, ejection sound | Pulmonary stenosis, atrial septal defect |
| Venous hum | Infraclavicular throughout the cardiac cycle (right side > left side), diminishes with jugular vein palpation or neck turning | PDA |
| Supraclavicular arterial bruit | Above clavicles | aortic stenosis, bicuspid aortic valve |
| Peripheral pulmonary stenosis | low-pitch with radiation to back and armpit | PDA, pulmonary stenosis |
LLSB = lower left sternal border
