Heart Murmurs Part 2-Congenital Heart Disease


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May 09 2018 18 mins   14
Heart murmurs continue with congenital heart diseases.
A Picmonic is available for EVERY topic in today’s episode. Start by checking out our first topic here.
Ventricular Septal Defect

* #1 type of congenital heart disease
* Loud, high-pitched harsh, holosystolic murmur at LLSB
* Typically a left to right shunt (restrictive)

* May switch to right to left 2/2 pulmonary HTN (non-restrictive)

* “Eisenmenger’s syndrome”

* Dx: echocardiogram
* Tx:

* Observe if small

* Most close by age 10

* Surgery

* Symptomatic
* CHF
* Growth Delay
* Large VSDs repaired by age 2

Atrial Septal Defect

* Ostium secundum fails to close
* Often asymptomatic until >30y.o.
* Systolic ejection crescendo-decrescendo flow murmur @ pulmonic area (Left sternal border)

* Mimics pulmonic stenosis

* Widely split, fixed s2

* Does not vary with inspiration

* It’s not on either side of the heart

* Surgery if symptomatic

Coarctation of the aorta

* Narrowing of descending thoracic aorta
* Males>females
* 70% also have bicuspid aortic valve
* Symptoms

* Systolic murmur that radiates to the back/scapula/chest
* HTN (secondary)
* BP upper>lower extremities
* Delayed/weak femoral pulses

* Diagnosis

* Angiogram=gold standard
* CXR:

* Rib notching

* Increased flow in intercostal aa.

* 3 sign

* Narrowed aorta looks like the notch of a 3

* Tx: surgical

Patent Ductus Arteriosus (PDA)

* Connection between descending thoracic aorta & pulmonary artery
* Continuous, machinery murmur loudest @ pulmonic area
* Wide pulse pressure, bounding peripheral pulses
* Dx: echocardiogram
* Tx: indomethacin

* Inhibits prostaglandin production=closes PDA

Hypertrophic Cardiomyopathy

* Subaortic outflow obstruction secondary to hypertrophied septum
* Harsh, systolic, crescendo-decrescendo murmur at LLSB (similar to AS)

* DECREASES with INCREASED venous return

* Squatting, lying supine, etc
* Increased blood pushes septum out of the way

* INCREASES WITH DECREASED VENOUS RETURN

* Valsalva/standing

* Symptoms:

* Dyspnea usually 1st
* Chest pain
* Sudden cardiac death

* Especially during extreme exertion

* Secondary to v fib.

* Dx: echocardiogram
* Management:

* Avoid dehydration & extreme exertion
* B blockers 1st line medical

* Increases diastolic filling time

* Caution with digoxin, nitrates, and diuretics
* Surgical: myomectomy or alcohol septal ablation

Tetralogy of Fallot

* #1 cyanotic congenital heart disease
* Definition

* RV hypertrophy
* Rv outflow obstruction

* Pulmonary artery stenosis

* Overriding aorta
* VSD

* Right to left shunt=cyanotic

* “tet spells”

* Episodes of cyanosis
* Relieved by squatting

* Harsh,