Evaluation of Heart Murmurs in
Children and Adolescents
Amy is a 16 yr old adolescent who has recently experienced
short bouts of palpitations. These occur suddenly at rest, last a few minutes,
abate spontaneously and abruptly, and are not associated with shortness of
breath, chest discomfort or dizziness. She is very active in sports. Her medical
history is unremarkable. There is no family history of palpitations, cardiomyopathy,
mitral valve prolapse or sudden death. Her PMI is in the normal position and
the cardiac impulse is normal. There is no thrill. Amy was auscultated first
supine and then standing.With the stethoscope at the left lower sternal border,
using the diaphragm the following sounds were recorded. Listen
to the heart sound. Follow this approach to prepare for the pretest.
- Can you identify S1 and S2?
- Are they normal?
Yes or No
- Are there any clicks?
Yes or No
- Is there an S3 or an S4?
Yes or No
- Is there a murmur? If so what type is it?
- If you detect a murmur, can you tell whether it is functional or organic?
Can you suggest a diagnosis? Do you think that the patient should be referred
to a pediatric cardiologist?
Yes or No
Yes or No
Yes or No
Take the pretest