Heart Auscultation Quiz
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4 year old boy, asymptomatic. Normal growth and development. On examination has slightly increased heart rate and radial and femoral pulses are definitely increased. Heart action also slightly increased. You listen in the left upper sternal edge.
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6.1 S1 not audible
6.2 S2 not audible
6.3 Continuous murmur, louder in systole than diastole
6.4 Continuous murmur
Conclusion: This child has a significant patent ductus arteriosus (PDA) causing increased heart rate and bounding pulses as well as a continuous murmur which is loud enough to obscure the heart sounds. It is louder in systole since aortic pressure is higher then. The murmur would also be well heard in the left upper back medial to the scapula.
There are much rarer causes of continuous murmurs such as arterio-venous and coronary fistulae but the PDA is by far the most common cause. The PDA needs to be closed, likely with a device placed by catheter.
Your assessment of this child’s heart:Correct
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