Heart Auscultation Quiz
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7 year old girl, normal growth and development, no symptoms. Normal heart action and pulses. Routine examination. You listen at the left sternal edge, 4th interspace.
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4.1 Normal heart rate
4.2 S1 present but hard to hear clearly due to murmur
4.3 S2 present but hard to hear clearly due to murmur
4.4 Systole: pan/holosystolic murmur, 3/6, harsh quality
4.5 Diastole: no sounds
Conclusion: In children a pansystolic murmur, termed regurgitant by some, is most likely due to a small VSD. It occupies all of systole with uniform loudness as the pressure gradient between the ventricles persists throughout systole, unlike valve stenosis murmurs where the pressure builds up and declines, giving a diamond shaped ejection murmur. The harsh sound is due to turbulence in the jet from left to right ventricle. No symptoms would be likely and the defect will likely shrink or close completely with time. No physical restrictions are needed. A cardiac consultation would be important to exclude valve abnormalities as well. In adults this type of murmur would most likely be from mitral regurgitation, very uncommon in children.
Her heart rate is:Correct
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