Megan Puckett-Pediatric Cardiology for the Primary Care Practitioner
(The notes I took are rather messy because I was taking them as I watched the presentation, but I added them at the bottom anyways in case you need them.)
The presentation I watched on childhood heart disease was very informative. I felt as though I could recommend a child to a pediatric cardiologist myself after watching it. Dr. Joshua Donner talked about everything a person could ever want to know about heart murmurs. He chose this topic because they are extremely common in children.
I myself had no idea that heart murmurs were as common in pediatric patients as they are. Dr. Donner said they are commonly found in as many as 80%-100% of children at some point in time. I also always thought that heart murmurs were very hazardous to a person’s health, especially that of a child; however, that is not always the case. There are two major groups of heart murmurs. These groups are known as innocent heart murmurs and non-innocent heart murmurs. Dr. Donner touched on both types and gave examples.
He basically summed it up as an innocent heart murmur is louder when the patient is lying down and much softer when they are standing. Innocent murmurs are also not associated with any other cardiac symptoms. They also do not cause a clicking sound. Non-innocent heart murmurs are normally recognized by the clicking sound they cause. They can also be recognized because they sound level increases when the patient is standing, rather than lying down.
He concluded his presentation by talking about reasons children are normally referred to a pediatric cardiologist. The reasons included parental concern, family heart disease, or the recognition of uncommon cardiac disease symptoms.
Overall, I actually enjoyed hearing him talk about the different types of murmurs. His presentation was very informative and designed very efficiently. I feel like I really took a lot from this assignment.
Notes:
Dr. Joshua Donner
Heart murmurs:
-Common to detect in baby child or teenager
-causes unnecessary tension of guardians
-Heart murmur? – sound you hear through stethoscope
-very common -80-100% of children diagnosed
-rarely anything wrong with heart
Common innocent heart murmurs:
-majority
-age 3 or 4 checkup-frequently hear murmur
-Still’s Murmur -most common
-systolic
-louder when lying flat; quiet when sitting or standing
-loud w/ fever
-vibratory along left lower sternum border
-loud but can’t feel with hand
-referred to cardiologist-normally innocent
-no cardiac symptoms
-not palpable
-no click
-diastolic component
Normal pulse
No resp. troubles
Normal ekg
No sign of valve disease or hole in heart
No meds/restriction from activity needed
Have for several years-dissappear teen years
Newborn period too
-PPS murmur
-mainly babies
Once left hospital; small(usually) can be in normal
Picked up @ 2week
Left upper sternum border left/right upper chest/sides/back
Systolic;blowing quality
Reason? Little blood flow to lounges durin development; vessels are small More flow after birth, turbulence=murmur
No other symptoms
First several months of life usually ends around 7-8
Pulmonary flow murmur
Teen pre-sports phys.
Left upper s.b.-systolic
Louder when flat softer when standing
Cannot feel
No other abnormal cardiac findings
Not normally ass. w/ cardiac disease
Venous hum
Well child checkup 3-8
Clavical-left/right uppewr chest
Continuous murmur
Blowing/machinery sound
Rarely heard when flat/common when upright
Normal ekg& echocardiogram
Flow passing vain & chest area
Corroted bruey
Child-fine; adult-could be peripheral vascular disease
Can feel in neck vessels
No other abnormal findings
Abnormal-pathological:
bicuspid aortic valve
3leaflets-some only 2
2leaflet-valve not open peacefully or leak
Systolic right upper chest
Clicking sound
Diastolic murmur-leaking
Systolic murmer 2ndary to vsd
Vsd-hole in wall separating ventricle
Blood flow turbulent as heart squeezes
Left lower sternum border
2nd most common
Left upper-systolic
Pulmonary valve allows blood flow turbulent
Radiates into sides & back-click
Apex of chest during systily
Valve clicking
Mitrovalve leak
During systily-left midchest
Squatting to standing= louder rather than softer
Hypertrophic obstructive cardiomopothy-sudden death young athletes in play-don’t clear for sports
Reasons to refer patient to pediatric cardiologist:
-patient has cardiac symptoms
Passing out
Persi. Shortness of breath chest discomfort
Heart races
Freq dizzy/pale spells; baby-stop breathing
-family history for heart disease
-abnormal cardiac exam
Non innocent murmur
Large liver
Abnorm. In respiratory exam
-family concerned about heart
Interesting. You'll probably have a chance to 'hear' the heartbeat of someone with a murmur.I was surprised at the % of children with murmurs.
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