MURMUR IN THE NEWBORN BEYOND NEONATAL PERIOD

Murmur beyond neonatal period Benign 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 Examples: Pulmonary flow murmur Still murmur Venous hum Non-cardiac murmur (e.g., Anemia, hyperthyroidism) Pathological Features: 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 Categories: Congenital Heart Disease* See Approach to Murmur: Murmur in the Newborn (<48 hrs) Acquired Heart Disease Rheumatic heart disease Bacterial endocarditis Tricuspid insufficiency Mitral insufficiency Mitral valve prolapse Cardiomyopathy/myocarditis *Indicates Key Condition This is not an exhaustive list of medical conditions.