Murmur
Key Conditions
Key conditions are the core conditions that the Paediatric Undergraduate and Clerkship Directors of Canada (PUPDOC) felt are essential for graduating medical students to know. The Key Conditions are neither a differential diagnosis nor a clinical approach. They highlight conditions that may be unique to paediatrics, that are essential, or that are common. Key Conditions can present in a number of ways – each is listed as under the most common Clinical Presentation.
Clinical Approach
Clinical approaches represent one of many methods to think through a clinical presentation, and narrow down a differential diagnosis. There are many conditions that can present with similar symptomatology. These presentations are not meant to contain an exhaustive list of differential diagnoses, but rather outline how to think through patient signs and symptoms, and understand some of the most common and important Paediatric conditions. There are many different ways to approach any clinical presentation, and these approaches are not meant to replace clinical judgement.
Vignette
You are assessing a 24 hour old infant in the newborn nursery. On physical exam, you note a cardiac murmur
Diagrams
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Murmur in the Newborn
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Murmur Beyond the Neonatal Period
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Cyanosis in the Newborn
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Pre-Clerkship
Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.
Lectures
- Introduction to Pediatric Cardiology Course 3
- Left to right shunts Course 3
- Obstructive Lesions Course 3
- Approach to Pediatric EKGs Course 3
Small Groups
- Pediatric Pathology Course 3
- Pediatric Cardiac Cyanosis Course 3
- Pediatric Congestive Heart Failure Course 3
Clerkship
Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.
Objectives
By the end of the Paediatric Clerkship, a medical student will be able to:
- Describe the structural and dynamic changes that occur following birth in the cardiovascular system, including closure of the ductus arteriosus.
- Describe the classification system of murmurs.
- Describe the characteristics of “innocent” murmurs.
- List the indications for prostaglandin infusion in a newborn.
- Draw a picture, and describe the signs and symptoms, of each of the following:
- Ventricular septal defect
- Atrial septal defect
- Patent ductus arteriosus
- Tetralogy of Fallot
- Transposition of the great arteries
- Coarctation of the aorta
Half Day Cases
- 1. A 4 year old child is referred for assessment of a systolic murmur heard on recent well-child exam.
- 2. A 6 week old term infant with poor feeding is referred for assessment of a systolic murmur.
- 3. You are a pediatrician in a rural center. You are called to the delivery room urgently to see a term newborn with cyanosis and no murmur. The infant had an uncomplicated vaginal delivery.
- 4. A 6 year old child with a history of recurrent respiratory infections is referred for assessment of a systolic murmur.
Resources
The following resources have been reviewed and collated by canuc-paeds. These resources are aimed to provide information at the level of the medical student. These include overviews of topics, clinical resources, and useful guidelines that contain relevant materials.
Papers
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Park’s Pediatric Cardiology for Practitioners, 6th Edition.
; .
Available through UofC library e-books. -
Evaluation and Management of Heart Murmurs in Children. . Frank JE et al. .
; American Family Physician 2011; 84: 793-800. .
Review article on evaluation and management of murmurs. -
Lucille Packard Children’s Hospital at Stanford: Overview of Congenital heart Disease .
http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/cardiac/chd.html
() Includes diagrams and written descriptions of all congenital heart disease; provides an approach to the diagnosis of congenital heart disease. -
University of Washington: Demonstration of Heart Sounds & Murmurs .
http://depts.washington.edu/physdx/heart/demo.html
() This site includes audio demonstrations of heart sounds and murmurs, as well as includes links to the pathophysiology. -
Cincinnati Children's Hospital Heart Encyclopedia.
https://www.cincinnatichildrens.org/patients/child/encyclopedia
() This site describes the anatomy of common and rare congenital heart defects. Includes 3 dimensional videos. Medical students should focus on the common defects.
Cards
No cards.
Videos
No videos.