MURMUR IN THE NEWBORN BEYOND NEONATAL PERIOD

Benign Pathological Murmur beyond neonatal period Murmur: Clinical Approach to Murmur beyond the neonatal period *Indicates Key Condition This is not an exhaustive list of medical conditions. Congenital Heart Disease* Acquired Heart Disease Detailed history and physical exam See Approach to Murmur: Murmur in the Newborn (<48 hrs) Normal S2 Early systole, no diastolic component Low intensity Increased intensity with fever, anxiety Changes with position and Valsalva No family history of sudden death Exercise intolerance Syncope with exertion Cyanosis Abnormal S1 or S2 Loud or harsh murmur Diastolic, continuous, pansystolic or late systolic Ejection click Displaced apex Palpable heave/thrill Abnormal pulses Symptoms suggestive of congestive heart failure or shock Rheumatic heart disease Bacterial endocarditis Tricuspid insufficiency Mitral insufficiency Mitral valve prolapse Cardiomyopathy/myocarditis Pulmonary flow murmur Still murmur Venous hum Non-cardiac murmur (Eg. *Anemia, hyperthyroidism)