Question

As a FNP you will get the opportunity to diagnose heart murmurs. This usually causes panic in parents, so you need to understand what you are hearing. Describe a situation in which you diagnose a heart murmur on a pediatric patient. Include grade/intensity, timing in cardiac cycle, location on the chest where murmur is the loudest, radiations or transmission, quality, duration and pitch. Name the murmur and follow-up recommendations.

Answer 1

Once a mother complained that her 6 month old boy is not gaining weight, becoming breathless while feeding and crying. Baby is not active while playing with toys etc.!

On examining the baby, a murmur was heard :

• Grade : A grade - 4 murmur is heard (i.e, murmur is loud and associated with palpable thrill)
• Timing in cardiac cycle : Murmur begins with the first heart sound and extended through second heart sound (IT IS A HOLOSYSTOLIC MURMUR)
• The murmur is best heard at lower left sternal border ( 3 rd and 4th intercoastal space)
• Radiation : sound radiates to aortic area, tricuspid area, mitral area.
• The murmur is of HIGH PITCH
• It is a harsh murmur (indicating high velocity blood flow from high pressure to low pressure.)

From all these findings I came to conclusion that baby boy has VENTRICULAR SEPTUM DEFECT. The murmur heard is PAN SYSTOLIC MURMUR.

​​​​​​​I'll type remaining answer in comments,sorry for inconvenience :(