DOCSLIB.ORG

Auscultation While Standing: a Basic and Reliable Method to Rule out a Pathologic Heart Murmur in Children

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Auscultation While Standing: a Basic and Reliable Method to Rule out a Pathologic Heart Murmur in Children Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children 1,2,3 Bruno Lefort, MD ABSTRACT 1 Elodie Cheyssac, MD PURPOSE The distinction between physiologic (innocent) and pathologic Nathalie Soulé, MD1 (organic) heart murmurs is not always easy in routine practice, leading too often to unnecessary cardiology referrals and expensive investigations. We aimed to 1 Jacques Poinsot, MD test the hypothesis that the complete disappearance of murmur on standing can Marie-Catherine Vaillant, MD1 exclude cardiac disease in children. Alaeddin Nassimi MD4 METHODS From January 2014 to January 2015, we prospectively included 194 1,2 consecutive children aged 2 to 18 years who were referred for heart murmur Alain Chantepie, MD, PhD evaluation to pediatric cardiologists at 2 French medical centers. Heart murmur 1Children Hospital Gatien de Clocheville, characteristics while supine and then while standing were recorded, and an echo- University Hospital Centre of Tours, Tours, cardiogram was performed. France RESULTS Overall, 30 (15%) of the 194 children had a pathologic heart murmur 2University François Rabelais, Tours, France as determined by an abnormal echocardiogram. Among the 100 children (51%) 3INSERM UMR 1069 - Nutrition, Crois- who had a murmur that was present while they were supine but completely dis- sance et Cancer, Tours, France appeared when they stood up, only 2 had a pathologic murmur, and just 1 of 4University Hospital Centre of Poitiers, them needed further evaluation. Complete disappearance of the heart murmur Poitiers, France on standing therefore excluded a pathologic murmur with a high positive predic- tive value of 98% and specificity of 93%, albeit with a lower sensitivity of 60%. CONCLUSIONS Disappearance of a heart murmur on standing is a reliable clini- cal tool for ruling out pathologic heart murmurs in children aged 2 years and older. This basic clinical assessment would avoid many unnecessary referrals to cardiologists. Ann Fam Med 2017;15:523-528. https://doi.org/10.1370/afm.2105. INTRODUCTION eart murmur is a clinical finding currently affecting about 65% to 80% of schoolchildren1,2 and one of the most common reasons Hfor referral to cardiologists. Most murmurs are physiologic (inno- cent)3 and result from the normal pattern of blood flow through the car- diac cavities and vessels. In a few cases, however, the murmur may be the single symptom of cardiac disease, even if most congenital heart diseases are diagnosed before birth or during the first year of life.1 Differences between physiologic and pathologic murmurs are well Annals Journal Club selection; known,4-9 but primary care physicians in family medicine or pediatricians see inside back cover or http://www.annfa- too frequently refer their patients to pediatric cardiologists because they mmed.org/AJC/. fear missing a heart disease diagnosis, resulting in unneeded parental anxiety, time consumption, and expensive evaluations.10,11 Several clinical Conflicts of interest: authors report none. features of the murmur such as intensity, timing, quality and pitch, and the presence of a click are subjective and require extensive training for use to distinguish between physiologic and pathologic murmur. A simple, CORRESPONDING AUTHOR objective, and robust clinical test to exclude cardiac disease in apparently Bruno Lefort, MD healthy children could prevent many unnecessary referrals. Children Hospital Gatien de Clocheville McLaren et al12 reported that the prevalence of physiologic heart University Hospital Centre of Tours 49 Bd Béranger murmur in schoolchildren was 65% when they were in a supine position, 37044 Tours Cedex 01, France whereas it was only 15% when they were standing. To our knowledge, [email protected] however, no study has demonstrated that the disappearance of murmur ANNALS OF FAMILY MEDICINE ✦ WWW.ANNFAMMED.ORG ✦ VOL. 15, NO. 6 ✦ NOVEMBER/DECEMBER 2017 ANNALS OF FAMILY MEDICINE ✦ WWW.ANNFAMMED.ORG ✦ VOL. 15, NO. 6 ✦ NOVEMBER/DECEMBER 2017 PB 523 AUSCULTATION WHILE STANDING on standing can allow clinicians to rule out a murmur the included children provided their informed consent, generated by underlying pathology. In this study, we and the Ethics Committee for Human Research of the aimed to test the disappearance of heart murmur in Tours Hospital approved the study. We excluded chil- standing children, aged 2 years and older, as a reliable dren aged younger than 2 years, those who could not test to exclude pathologic murmur. stand for at least 1 minute, and those who had already been examined by a cardiologist or pediatric cardiolo- gist, or who had already had an echocardiogram. METHODS Six pediatric cardiologists participated in the Between January 2014 and January 2015, we prospec- study. They collected the child’s personal history of tively included in our study 194 consecutive children cardiopulmonary symptoms: dyspnea at rest or during referred to pediatric cardiologists at 2 French univer- exercise, palpitations, syncope, and failure to thrive or sity hospital centers (156 referred to Tours Medical grow. They also noted the characteristics of heart aus- Center, 38 referred to Poitiers Medical Center) for cultation with an acoustic-based, nonelectronic stetho- evaluation of heart murmur. Children with genetic or scope, first with the patient in the supine position, systemic disorders or a family history of heart disease and then for at least 1 minute in the standing position: were excluded, as these findings on their own are suf- presence or absence of the murmur, timing (systolic, ficient to prompt referral to a specialist. All parents of diastolic, both, continuous), location of maximal Table 1. Clinical and Echocardiographic Characteristics of the 30 Children With Abnormal Findings on an Echocardiogram Murmur Reduction of Age, While Intensity While Patient Sex y Standing Standing Location Radiation Timing Symptoms Cardiac Disease Patient 1 M 12 No NA Low to middle left sternal border No Systolic No Muscular VSD Patient 2 F 13 No NA Left upper sternal border No Systolic No ASD OS Patient 3 M 7 Yes No Left upper sternal border No Systolic Yes ASD OS Patient 4 F 10 Yes No Apex Yes Systolic No Mitral regurgitation Patient 5 F 6 Yes No Apex No Systolic No Mitral regurgitation Patient 6 F 5 Yes Yes Left upper sternal border No Systolic No ASD OS Patient 7 F 10 Yes Yes Low to middle left sternal border No Systolic Yes Mitral regurgitation Patient 8 F 13 Yes Yes Low to middle left sternal border No Systolic No Mitral regurgitation Patient 9 F 5 Yes No Low to middle left sternal border Yes Systolic No Aortic stenosis Patient 10 F 5 Yes Yes Left upper sternal border No Systolic No ASD OS Patient 11 F 8 Yes No Left upper sternal border No Systolic No ASD OP Patient 12 F 13 Yes Yes Left upper sternal border No Systolic No Pulmonary stenosis Patient 13 F 5 Yes No Apex No Systolic No Mitral regurgitation Patient 14 F 6 Yes Yes Low to middle left sternal border No Systolic No Coronary-to–pulmonary artery fistula Patient 15 M 9 Yes No Low to middle left sternal border No Systolic No Perimembranous VSD Patient 16 M 2 Yes No Low to middle left sternal border No Systolic Yes Muscular VSD Patient 17 M 4 Yes No Low to middle left sternal border No Systolic No Muscular VSD Patient 18 M 9 Yes Yes Low to middle left sternal border Yes Systolic Yes Muscular VSD, ASD OS Patient 19 M 4 Yes Yes Low to middle left sternal border No Systolic Yes Muscular VSD Patient 20 M 12 Yes Yes Low to middle left sternal border Yes Systolic No Tricuspid regurgitation Patient 21 M 6 Yes No Low to middle left sternal border No Systolic No Mitral regurgitation Patient 22 M 2 Yes Yes Low to middle left sternal border Yes Systolic No Coarctation of aorta Patient 23 M 6 Yes No Right upper sternal border Yes Systolic No Mitral regurgitation Patient 24 M 10 Yes No Right upper sternal border Yes Systolic No Aortic stenosis Patient 25 M 3 Yes No Left upper sternal border Yes Systolic No ASD OS Patient 26 M 5 Yes Yes Right upper sternal border Yes Systolic No Aortic stenosis Patient 27 M 2 Yes No Left upper sternal border No Systolic Yes ASD OP Patient 28 M 13 Yes Yes Left upper sternal border No Systolic No ASD OP Patient 29 M 4 Yes No Left upper sternal border No Systolic Yes ASD OS Patient 30 F 2 Yes Yes Under left clavicle Yes Continuous No PDA ASD = atrial septal defect; F = female; M = male; NA = not applicable; OP = ostium primum; OS = ostium secundum; PDA = patent ductus arteriosus; VSD = ventricular septal defect. ANNALS OF FAMILY MEDICINE ✦ WWW.ANNFAMMED.ORG ✦ VOL. 15, NO. 6 ✦ NOVEMBER/DECEMBER 2017 524 AUSCULTATION WHILE STANDING intensity (right upper sternal border, left upper sternal data. Analyses were performed using Prism version 5 border, low to middle left sternal border, under left (GraphPad Software, Inc). Statistical significance was clavicle, apex, back), and radiation (yes, no). Changes defined as aP <.05. in intensity (higher, lower, or comparable) between supine and standing positions were also evaluated when a murmur was present in both positions. After RESULTS this physical examination had been completed, all chil- Among the 194 children studied, 30 (15%) had abnor- dren then had an echocardiogram to assess the pres- mal findings on echocardiogram that explained the ence or absence of cardiac anomalies that could explain murmur. The cardiac diseases diagnosed were atrial the murmur. Trivial valvular regurgitations and patent septal defects (ASDs) in 9 children, ventricular septal foramen ovale were considered to be physiologic and defects (VSDs) in 5, ASD associated with VSD in 1, not to explain the murmur. sonographically important mitral regurgitation in 7, Descriptive data are presented as means ± stan- tricuspid regurgitation in 1, aortic valve stenosis in dard deviations, and diagnostic performance data are 3, pulmonary valve stenosis in 1, coarctation of the presented as values with 95% confidence intervals.
Load more

Recommended publications
  • Innocent (Harmless) Heart Murmurs in Children
    JAMA PATIENT PAGE The Journal of the American Medical Association PEDIATRIC HEART HEALTH Innocent (Harmless) Heart Murmurs in Children murmur is the sound of blood flowing through the heart and the large blood vessels that carry the blood through the body. Murmurs can be a A sign of a congenital (from birth) heart defect or can provide clues to illnesses that start elsewhere in the body and make the heart work harder, such as anemia or fever. In children, murmurs are often harmless and are just the sound of a heart working normally. These harmless murmurs are often called innocent or functional murmurs. Murmurs are easily heard in children because they have thin chests and the heart is closer to the stethoscope. When children have fevers or are scared, their hearts beat faster and murmurs can become even louder than usual. TYPES OF INNOCENT MURMURS • Still murmur is usually heard at the left side of the sternum (breastbone), in line with the nipple. This murmur is harder to hear when a child is sitting or lying on his or her stomach. • Pulmonic murmur is heard as blood flows into the pulmonary artery (artery of the lungs). It is best heard between the first 2 ribs on the left side of the sternum. • Venous hum is heard as blood flows into the jugular veins, the large veins in the neck. It is heard best above the clavicles (collarbones). Making a child look down or sideways can decrease the murmur. CHARACTERISTICS OF INNOCENT MURMURS • They are found in children aged 3 to 7 years.
    [Show full text]
  • Practical Cardiac Auscultation
    LWW/CCNQ LWWJ306-08 March 7, 2007 23:32 Char Count= Crit Care Nurs Q Vol. 30, No. 2, pp. 166–180 Copyright c 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins Practical Cardiac Auscultation Daniel M. Shindler, MD, FACC This article focuses on the practical use of the stethoscope. The art of the cardiac physical exam- ination includes skillful auscultation. The article provides the author’s personal approach to the patient for the purpose of best hearing, recognizing, and interpreting heart sounds and murmurs. It should be used as a brief introduction to the art of auscultation. This article also attempts to illustrate heart sounds and murmurs by using words and letters to phonate the sounds, and by presenting practical clinical examples where auscultation clearly influences cardiac diagnosis and treatment. The clinical sections attempt to go beyond what is available in standard textbooks by providing information and stethoscope techniques that are valuable and useful at the bedside. Key words: auscultation, murmur, stethoscope HIS article focuses on the practical use mastered at the bedside. This article also at- T of the stethoscope. The art of the cardiac tempts to illustrate heart sounds and mur- physical examination includes skillful auscul- murs by using words and letters to phonate tation. Even in an era of advanced easily avail- the sounds, and by presenting practical clin- able technological bedside diagnostic tech- ical examples where auscultation clearly in- niques such as echocardiography, there is still fluences cardiac diagnosis and treatment. We an important role for the hands-on approach begin by discussing proper stethoscope selec- to the patient for the purpose of evaluat- tion and use.
    [Show full text]
  • Heart Murmur, Incidental Finding
    412 Heart Murmur, Incidental Finding (asymptomatic) mitral valve regurgitation. Technician Tips Count Respirations and Monitor Respiratory Relevant inclusion criteria for the trial that Teaching owners to keep a log of their pet’s Effort) demonstrated this effect were a vertebral resting respiratory rates can allow early detection heart sum > 10.5, an echocardiographic left of HF decompensation so that medications can SUGGESTED READING atrial–aortic ratio > 1.6, and left ventricular be adjusted and hopefully hospitalization for Atkins C, et al: ACVIM consensus statement. enlargement. acute HF can be avoided. Guidelines for the diagnosis and treatment of • ACE inhibition may have a positive effect on canine chronic valvular heart disease. J Vet Intern the time to development of stage C HF in Client Education Med 23:1142-1150, 2009. canine patients with left atrial enlargement Management of the veterinary patient with AUTHOR: Jonathan A. Abbott, DVM, DACVIM due to mitral valve regurgitation. chronic HF requires careful monitoring and EDITOR: Meg M. Sleeper, VMD, DACVIM • Evidence that medical therapy slows the relatively frequent adjustment of medical progression of HCM is lacking. therapy (see client education sheet: How to Client Education Heart Murmur, Incidental Finding Sheet Initial Database BASIC INFORMATION rate or body posture), short (midsystolic), single (unaccompanied by other abnormal • Thoracic radiographs may be considered Definition sounds), and small (not widely radiating). as the initial diagnostic test in small- to A heart murmur that is detected in the process medium-breed dogs with systolic murmurs of an examination that was not initially directed Etiology and Pathophysiology that are loudest over the mitral valve at the cardiovascular system • A heart murmur is caused by turbulent blood region.
    [Show full text]
  • Auscultation of Abdominal Arterial Murmurs
    Auscultation of abdominal arterial murmurs C. ARTHUR MYERS, D.O.,° Flint, Michigan publications. Goldblatt's4 work on renal hyperten- sion has stimulated examiners to begin performing The current interest in the diagnostic value of ab- auscultation for renal artery bruits in their hyper- dominal arterial bruits is evidenced by the number tensive patients. of papers and references to the subject appearing in Stenosis, either congenital or acquired, and aneu- the recent literature. When Vaughan and Thoreki rysms are responsible for the vast majority of audi- published an excellent paper on abdominal auscul- ble renal artery bruits (Fig. 2). One should be tation in 1939, the only reference they made to highly suspicious of a renal artery defect in a hy- arterial murmurs was that of the bruit of abdominal pertensive patient with an epigastric murmur. Moser aortic aneurysm. In more recent literature, however, and Caldwell5 have produced the most comprehen- there is evidence of increased interest in auscultat- sive work to date on auscultation of the abdomen ing the abdomen for murmurs arising in the celiac, in renal artery disease. In their highly selective superior mesenteric, splenic, and renal arteries. series of 50 cases of abdominal murmurs in which The purpose of this paper is to review some of aortography was performed, renal artery disease the literature referable to the subject of abdominal was diagnosed in 66 per cent of cases. Their con- murmurs, to present some cases, and to stimulate clusions were that when an abdominal murmur of interest in performing auscultation for abdominal high pitch is found in a patient with hypertension, bruits as a part of all physical examinations.
    [Show full text]
  • Viding Diagnostic Insights Into the Pathophysiologic Mechanisms
    viding diagnostic insights into the pathophysiologic mechanisms under- lying the acoustic findings heard in clinical practice.162-165 Contemporary physicians should take advantage of the valuable clinical information that can be obtained by such an inexpensive instrument and expedient and reli- able tool as the stethoscope. The following section reviews the funda- mental technique of cardiac auscultation, emphasizing the diagnostic value and practical clinical applications of this time-honored (but endan- gered) art in this time of need.166 The Art and Technique of Cardiac Auscultation. Auscultation of the heart and vascular system is one of the most challenging and rewarding clinical diagnostic skills that can (and should) be learned and applied by every prac- ticing physician. Proficiency in cardiac auscultation requires experience, repeated practice, and a great deal of patience (and patients). Most impor- tantly, it requires a proper state of mind. (“we hear what we listen for”). Although the most vital component of the auscultatory apparatus lies between the earpieces, the proper use of a well-designed, efficient stetho- scope cannot be overemphasized. To ensure optimal sound transmission, the well-crafted stethoscope should be airtight, with snug but comfortably-fit- ting earpieces, properly aligned metal binaurals, and flexible, double-barrel, 1 thick-walled tubing, ⁄8 inch in internal diameter and no more than 12 to 15 inches in length. A high-quality stethoscope should be equipped with both bell and diaphragm chest pieces. The bell, when applied gently to the skin, will “bring out” low frequency sounds and murmurs (eg, faint S4 or S3 gal- lop or diastolic rumble) and the diaphragm, when pressed firmly against the skin, will accentuate high-pitched acoustic events (eg, diastolic blowing murmur of AR).
    [Show full text]
  • Intra-Operative Auscultation of Heart and Lungs Sounds: the Importance of Sound Transmission
    Intra-Operative Auscultation of more readily when stethoscopes are used. Loeb Heart and Lungs Sounds: (2) has reported that the response time to detect an abnormal value on an intraoperative The Importance of Sound monitor display and it was 61 seconds with 16% Transmission of the abnormal values not being recognized in 5 minutes. Whereas, Copper et al, (3) found the Anthony V. Beran, PhD* meantime between an event and detection with a stethoscope was 34 seconds. This Introduction suggests that changes in cardio-pulmonary function may be detected more readily with a Sometimes we put so much emphasis on stethoscope (1). Auscultation of heart and lung electronic monitoring devices we forget that sounds during perioperative period is useful our own senses often detect things before a only if the Esophageal Stethoscope provides machine can. Seeing condensation in airway strong, clear transmission of the sounds to the device or clear mask can serve to indicate the anesthesia provider. This study evaluates the presence of ventilation before the signal has sound transmission properties of several even reached the equipment. Sometimes the Esophageal Stethoscopes currently available in sense of smell can be the first thing to aid in the the market. detection of a disconnected airway device or circuit. Similarly, in some situations listening for Methods the presence of abnormal heart or airway sounds can help detect the onset of critical To evaluate the sound transmission properties incidents quicker than electronic monitors. But of the Esophageal Stethoscopes in vitro study in recent years the art of listening has changed was performed. A system that simulates the in the practice of Anesthesia.
    [Show full text]
  • Jugular Venous Pressure
    NURSING Jugular Venous Pressure: Measuring PRACTICE & SKILL What is Measuring Jugular Venous Pressure? Measuring jugular venous pressure (JVP) is a noninvasive physical examination technique used to indirectly measure central venous pressure(i.e., the pressure of the blood in the superior and inferior vena cava close to the right atrium). It is a part of a complete cardiovascular assessment. (For more information on cardiovascular assessment in adults, see Nursing Practice & Skill ... Physical Assessment: Performing a Cardiovascular Assessment in Adults ) › What: Measuring JVP is a screening mechanism to identify abnormalities in venous return, blood volume, and right heart hemodynamics › How: JVP is determined by measuring the vertical distance between the sternal angle and the highest point of the visible venous pulsation in the internal jugular vein orthe height of the column of blood in the external jugular vein › Where: JVP can be measured in inpatient, outpatient, and residential settings › Who: Nurses, nurse practitioners, physician assistants, and treating clinicians can measure JVP as part of a complete cardiovascular assessment What is the Desired Outcome of Measuring Jugular Venous Pressure? › The desired outcome of measuring JVP is to establish the patient’s JVP within the normal range or for abnormal JVP to be identified so that appropriate treatment may be initiated. Patients’ level of activity should not be affected by having had the JVP measured ICD-9 Why is Measuring Jugular Venous Pressure Important? 89.62 › The JVP is
    [Show full text]
  • Heart Murmur
    Sacramento Heart & Vascular Medical Associates February 18, 2012 500 University Ave. Sacramento, CA 95825 Page 1 916-830-2000 Fax: 916-830-2001 Patient Information For: Only A Test Heart Murmur What is a heart murmur? A heart murmur is a sound that occurs between beats of the heart. The sound is made by blood flowing through the heart. It is similar to the sound water makes as it flows through a hose. A heart murmur does not necessarily mean that there is something wrong with the heart. How does it occur? Murmurs can result from: - the shape of the heart - abnormal heart structures, such as the valves or heart walls, which you may have had since birth - damaged or overworked heart valves resulting from medical problems such as rheumatic fever, heart attacks, infective endocarditis. When your heart beats faster, it changes the rate and amount of blood moving through your heart. This can cause heart murmurs. Some of the conditions that can cause your heart to beat faster are: - anemia - high blood pressure - pregnancy - fever - stress - thyroid problems. Most heart murmurs are heard in people with normal hearts. These innocent heart murmurs - also called functional, normal, vibratory, or physiologic murmurs - are harmless. They are common in children. Most murmurs go away for good as a child nears adulthood. What are the symptoms? Innocent heart murmurs do not cause any symptoms. If you have a heart problem that is causing the murmur, possible symptoms of a heart problem are: - shortness of breath - lightheadedness - decreased ability to exert yourself, for example, during activities such as climbing the stairs or even making a bed - frequent experiences of a rapid heart rate - chest pain.
    [Show full text]
  • The Carotid Bruit on September 25, 2021 by Guest
    AUGUST 2002 221 Pract Neurol: first published as 10.1046/j.1474-7766.2002.00078.x on 1 August 2002. Downloaded from INTRODUCTION When faced with a patient who may have had a NEUROLOGICAL SIGN stroke or transient ischaemic attack (TIA), one needs to ask oneself some simple questions: was the event vascular?; where was the brain lesion, and hence its vascular territory?; what was the cause? A careful history and focused physical examination are essential steps in getting the right answers. Although one can learn a great deal about the state of a patient’s arteries from expensive vascular imaging techniques, this does not make simple auscultation of the neck for carotid bruits redundant. In this brief review, we will therefore defi ne the place of the bruit in the diagnosis and management of patients with suspected TIA or stroke. WHY ARE CAROTID BRUITS IMPORTANT? A bruit over the carotid region is important because it may indicate the presence of athero- sclerotic plaque in the carotid arteries. Throm- boembolism from atherosclerotic plaque at the carotid artery bifurcation is a major cause of TIA and ischaemic stroke. Plaques occur preferentially at the carotid bifurcation, usually fi rst on the posterior wall of the internal carotid artery origin. The growth of these plaques and their subsequent disintegration, surface ulcera- tion, and capacity to throw off emboli into the Figure 1 Where to listen for a brain and eye determines the pattern of subse- bifurcation/internal carotid quent symptoms. The presence of an arterial http://pn.bmj.com/ artery origin bruit – high up bruit arising from stenosis at the origin of the under the angle of the jaw.
    [Show full text]
  • Heart Murmur
    PATCHS PROGRAM PUBLIC HEALTH NURSE ADVOCATES TEACHING CHILD HEALTH AND SAFETY Riverside County Community Health Agency HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE (HCPCFC) COURT FLASH NEWSLETTER VOLUME 1 ISSUE 36 APRIL 2011 Medical Information Fact Sheet Heart Murmur What is a Heart Murmur? Heart murmurs are extra or unusual sounds heard during a heartbeat. Sometimes they sound like a whooshing or swishing noise. Doctors can hear these sounds and heart murmurs using a stethoscope. Causes The two types of heart murmurs are innocent (harmless) and abnormal. Innocent heart murmurs: Why some people have innocent heart murmurs and others do not is not known. These murmurs are common in healthy children and do not pose a health threat. Children do not need to take any medicine or be careful in any special way. Extra blood flow through the heart also may cause innocent heart murmurs. After childhood, the most common cause of extra blood flow through the heart is pregnancy. This is because during pregnancy, women's bodies make extra blood. Most heart murmurs that occur in pregnant women are innocent. Abnormal heart murmurs: People with abnormal heart murmurs may have signs or symptoms of heart problems. Most abnormal murmurs in children are caused by congenital heart defects. They change the normal flow of blood through the heart. Sometimes a heart murmur indicates a problem with the child's heart, such as, a hole in the heart, a leak in a heart valve or, a narrow heart valve. In adults, abnormal heart murmurs most often are caused by acquired heart valve disease.
    [Show full text]
  • Evaluation of a Heart Murmur the Objectives of This Podcast Are Three-Fold: 1. First, to Help the Learner Identify Clinical
    PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on “Evaluation of a Heart Murmur.” These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio versions are accessible on iTunes or at www.pedcases.com/podcasts. Evaluation of a Heart Murmur This podcast was written by Dr. Andrew Mackie, a pediatric cardiologist at the Stollery Children's Hospital. Dr. Mackie is an Assistant Professor in the Departments of Pediatrics and Public Health Sciences at the University of Alberta. The objectives of this podcast are three-fold: 1. First, to help the learner identify clinical features that distinguish an innocent from a pathologic murmur. 2. Second, to recognize common innocent and pathologic murmurs using some audio examples. 3. And third, to feel comfortable explaining to parents what an innocent murmur is. Heart murmurs are very common in the general pediatric population. At least 50% of children have a murmur at some point in childhood. In fact of newborns examined every day for the first eight days of life, found that 77% had a heart murmur. Although heart murmurs are very common in infants and healthy children, the prevalence of congenital heart disease in the pediatric population is much lower; approximately 1%.Therefore, the great majority of children with murmurs have normal hearts. These children have innocent murmurs. Because heart murmurs are common in children, murmur evaluation is a common clinical scenario for the clinician. This is true for family physicians, general pediatricians, and pediatric cardiologists. The presence of a murmur is the most common reason for referral to pediatric cardiology.
    [Show full text]
  • Chest Auscultation: Presence/Absence and Equality of Normal/Abnormal and Adventitious Breath Sounds and Heart Sounds A
    Northwest Community EMS System Continuing Education: January 2012 RESPIRATORY ASSESSMENT Independent Study Materials Connie J. Mattera, M.S., R.N., EMT-P COGNITIVE OBJECTIVES Upon completion of the class, independent study materials and post-test question bank, each participant will independently do the following with a degree of accuracy that meets or exceeds the standards established for their scope of practice: 1. Integrate complex knowledge of pulmonary anatomy, physiology, & pathophysiology to sequence the steps of an organized physical exam using four maneuvers of assessment (inspection, palpation, percussion, and auscultation) and appropriate technique for patients of all ages. (National EMS Education Standards) 2. Integrate assessment findings in pts who present w/ respiratory distress to form an accurate field impression. This includes developing a list of differential diagnoses using higher order thinking and critical reasoning. (National EMS Education Standards) 3. Describe the signs and symptoms of compromised ventilations/inadequate gas exchange. 4. Recognize the three immediate life-threatening thoracic injuries that must be detected and resuscitated during the “B” portion of the primary assessment. 5. Explain the difference between pulse oximetry and capnography monitoring and the type of information that can be obtained from each of them. 6. Compare and contrast those patients who need supplemental oxygen and those that would be harmed by hyperoxia, giving an explanation of the risks associated with each. 7. Select the correct oxygen delivery device and liter flow to support ventilations and oxygenation in a patient with ventilatory distress, impaired gas exchange or ineffective breathing patterns including those patients who benefit from CPAP. 8. Explain the components to obtain when assessing a patient history using SAMPLE and OPQRST.
    [Show full text]