Benign Murmurs

You will all encounter these in your practice and on the floor. They are all benign and do not require SBE prophylaxis. Children with any of these otherwise grow and develop normally. You should try to get comfortable with the way these sound, because most kids shouldn't need cardiology consult.

Mnemonic: Please Please help me Sit (PPS). Still not in school, mom drives me to preschool in a hummer (venous hum), Pulmonary=Primary school, Give me a carrot anytime

1) Classic vibratory murmur (Still's)
* systolic
* max at MLSB or between LLSB and apex
* grade 2-3/6
* low-frequency, vibratory, "musical", "twanging string"
* seen in children 3-6y years old, and occasionally in infancy

2) Pulmonary ejection murmur
* early to midsystolic
* max at LUSB
* grade 1-3/6
* blowing quality
* older children (8-14 years old)

3) Pulmonary flow murmur of newborn (Peripheral pulmonary stenosis)
* systolic
* transmits to both axillae, left and right chest, and back
* grade 1-2/6
* usually disappears by 3-6 months old

4) Venous hum
* continuous
* right or left supraclavicular area
* grade 1-3/6
* inaudible in supine position
* intensity decreases with rotation of head and compression of
jugular vein
* 3-6 years old

5) Carotid bruit
* systolic
* right supraclavicular area and over carotids
* grade 2-3/6
* occasional thrill
* occur at any age
* DON'T LISTEN TO THE NECK!! (just a piece of advice)

Chief Resident Pearl. 7/04