A heart murmur is a common and important sign of precordial disease and is of great value for the diagnosis and differential diagnosis of precordial disease. In determining the clinical significance of the heart murmur, the following issues should be noted. 1, the heart murmur heard during physical examination does not always mean that the child is suffering from precocious heart disease In pediatric outpatient clinics, we often encounter some children referred from primary hospitals, who are suspected of having precocious heart disease because of the heart murmur found during the local physical examination, and are later diagnosed by cardiac ultrasound, chest X-ray and ECG.
In fact, the heart murmur in these children is not a predilection. In fact, these murmurs in children are functional (some people call them physiological murmurs or harmless murmurs).
Most of them are not clinically significant. The heart murmur heard in newborns and small infants should not be diagnosed hastily, but should be followed up periodically, if the murmur becomes weaker with age, it is mostly meaningless. Although some children with heart murmurs have the characteristics of organic murmurs, but also should be excluded from the acquired heart disease, especially in older children. 2, no heart murmur can not be completely excluded from children with precocious heart disease In clinical practice, there are indeed some children with precocious heart disease can be temporarily or always no heart murmur and often manifest cyanosis, heart enlargement and recurrent heart failure, such as right-sided heart, single ventricle, complete pulmonary vein ectopic drainage, etc.. At this time, children suspected of having precordial disease should undergo further auxiliary examinations in order to make a clear diagnosis. 3, not only according to the nature and characteristics of the heart murmur to make a judgment on the type of precocious heart disease In clinical practice, although many precocious heart murmur has a certain nature and characteristics, experienced doctors can be based on the characteristics of the murmur preliminary inference of the type of precocious heart disease, but this is not comprehensive, but also with other auxiliary examinations. For example, sometimes in the left edge of the sternum, the 2nd to 4th
For example, sometimes a coarse systolic murmur of grade III or higher is heard between the second and fourth ribs of the left sternal border, and the clinician often suspects a ventricular septal defect, while the ultrasound findings of the heart are aortic stenosis or pulmonary stenosis. This phenomenon of inconsistent clinical auscultation and auxiliary examination results can sometimes be encountered in practice, suggesting that the judgment of the type of precordial disease must be determined after a comprehensive analysis of the data. 4, it should be noted that in some cases the nature and (or) intensity of the heart murmur may change when the child with ventricular septal defect is combined with pneumonia and (or)
When a child with ventricular septal defect is combined with pneumonia and/or heart failure, the intensity of the murmur may decrease or become softer, while after pneumonia and/or heart failure improves, the murmur may become loud and rough again; in left-to-right shunt type of precordial disease, when obstructive pulmonary hypertension occurs, the heart murmur may become significantly weaker or disappear; in arteriovenous ductus arteriosus (
The characteristic sign of PDA is a continuous machine rolling murmur heard between the 2nd and 3rd ribs at the left border of the sternum, but in small infants, combined with pneumonia and/or heart failure, the murmur may become weaker or disappear.
In heart failure, pulmonary hypertension can be heard only as a systolic murmur because the pressure is equal in diastole and no shunt is generated. The clinician should make dynamic observations of the heart murmur in precordial disease, especially in hospitalized children, rather than making judgments about the presence and nature of cardiac lesions based solely on the results of cardiac auscultation at a particular moment in time, or else the diagnosis may be missed or misdiagnosed.