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Contents

  • cover of Understanding Pediatric Heart SoundsCHAPTER 1. The Heart as a Pump 1
    • THE CARDIAC CYCLE, 2
      • Electrical Events in the Cardiac Cycle, 2
      • Mechanical Events in the Cardiac Cycle, 3
    • VENTRICULAR FUNCTION, 5
      • Diastolic Ventricular Filling, 5
      • Systolic Ventricular Emptying, 5
      • The Frank-Starling Law, 6
    • THE CARDIAC VALVES AND PAPILLARY MUSCLES, 8
    • THE AORTIC PRESSURE CURVE, 9
    • HEART SOUNDS AND HEART FUNCTION, 11
    • CIRCULATORY CHANGES AT BIRTH, 11
    • COMMUNICATIONS BETWEEN SYSTEMIC AND PULMONARY CIRCULATIONS, 14
    • HEART FAILURE, 15
  • CHAPTER 2. Sound, Hearing, and the Stethoscope 17
    • NATURE OF SOUND, 17
    • HEARING, 19
    • THE STETHOSCOPE, 21
  • CHAPTER 3. History and Physical Examination of the Child with Heart Disease 27
    • HISTORY, 27
      • Chief Complaint, 27
      • Prenatal History, 28
      • Birth and Past Health History, 29
      • Family History, 32
    • PHYSICAL EXAMINATION, 32
      • Inspection, 36
      • Palpation, 42
    • BLOOD PRESSURE DETERMINATION, 50
    • ADDITIONAL DIAGNOSTIC METHODS, 53
      • Oximetry, 53
      • Chest X-ray, 54
      • Two-Dimensional Echocardiography, 54
      • Doppler Studies, 54
      • Cardiac Catheterization and Angiocardiography, 55
  • CHAPTER 4. Phonocardiography and the Recording of External Pulses
    • PHONOCARDIOGRAPHY, 57
    • ELECTROCARDIOGRAPHY, 58
    • CAROTID PULSE TRACING, 58
    • JUGULAR PULSE TRACING, 61
    • APEX CARDIOGRAPHY, 62
  • CHAPTER 5. Auscultation Areas, 65
    • TRADITIONAL AREAS TO AUSCULTATE, 65
    • REVISED AREAS TO AUSCULTATE, 66
      • Left Ventricular Area, 67
      • Right Ventricular Area, 67
      • Left Atrial Area, 68
      • Right Atrial Area, 68
      • Aortic Area, 69
      • Pulmonary Area, 70
      • Back and Head, 71
    • WHERE SHOULD ONE LISTEN? 72
    • MANEUVERS THAT AID CARDIAC AUSCULTATION, 72
  • CHAPTER 6. The First Heart Sound (S1), 75
    • THE ORIGIN OF S1, 75
    • THE NATURE OF S1, 75
    • LISTENING FOR S1, 76
    • SPLITTING OF S1, 77
      • Normal Splitting of S1, 77
      • Wide Splitting of S1, 77
    • INTENSITY OF S1, 78
      • Extracardiac Factors Affecting S1 Intensity, 78
      • Cardiac Factors Affecting S1 Intensity, 79
      • Pathologic Conditions Affecting S1 Intensity, 79
    • BEAT-TO-BEAT VARIATIONS OF S1, 80
  • CHAPTER 7. The Second Heart Sound (S2), 83
    • THE ORIGIN OF S2, 83
    • THE NATURE OF S2, 84
    • NORMAL (PHYSIOLOGIC) SPLITTING OF S2, 84
      • Listening for the Splitting Of S2, 86
      • ABNORMAL SPLITTING OF S21 86
      • Persistent Splitting of S2, 87
      • Wide Persistent Splitting of S2 with Respiratory Variation, 87
      • Wide Fixed Splitting Of S2, 88
      • Reversed Splitting of S2, 89
      • Single S2, 90
    • AMPLITUDE OF A2 and P2, 91
      • Loud P2, 91
      • Loud A2, 92
  • CHAPTER 8. The Third and Fourth Heart Sounds (S3 and S4), 95
    • IDENTIFYING EXTRA HEART SOUNDS, 95
    • THE THIRD HEART SOUND, 96
      • Origin of S3, 96
      • Listening for S3, 96
      • Pathology Associated with S3, 97
    • THE FOURTH HEART SOUND, 98
      • Origin Of S4, 98
      • Listening for S4, 98
      • Pathology Associated with S4, 99
    • SUMMATION GALLOP, 99
  • CHAPTER 9. Other Systolic and Diastolic Sounds, 103
    • SYSTOLIC CLICKS, 103
    • Differentiating Clicks from Other Sounds, 103
    • MIDSYSTOLIC CLICK, 105
      • Identifying the Midsystolic Click, 105
      • Echocardiography in the Diagnosis of Mitral Valve Prolapse, 105
      • Management of Mitral Valve Prolapse, 105
    • AORTIC EJECTION SOUNDS, 106
      • Origin and Nature of Aortic Ejection Sounds, 106
      • Listening for Aortic Ejection Sounds, 107
    • PULMONIC EJECTION SOUNDS, 107
      • Origin and Nature of Pulmonic Ejection Sounds, 107
      • Listening for Pulmonic Ejection Sounds, 107
    • SYSTOLIC WHOOPS, 108
      • Origin and Nature of Systolic Whoops, 108
      • Management of Whoops, 109
    • OPENING SNAP OF THE MITRAL VALVE, 109
      • Origin of the Mitral Opening Snap, 109
      • Listening for the Mitral Opening Snap, 110
      • Differentiating the Mitral Opening Snap from Other Sounds, 110
    • OPENING SNAP OF THE TRICUSPID VALVE, 112
      • Origin and Nature of the Tricuspid Opening Snap, 112
      • Listening for the Tricuspid Opening Snap, 112
  • CHAPTER 10. General Characteristics of Murmurs, 113
    • ORIGIN OF MURMURS, 113
      • Stenosis, 113
      • Regurgitation, 114
    • NATURE OF MURMURS, 114
      • Timing, 114
      • Loudness, 115
      • Pitch and Quality, 118
  • CHAPTER 11. Systolic Murmurs, 119
    • CLASSIFICATION OF SYSTOLIC MURMURS, 119
      • Ejection Murmurs, 119
      • Regurgitant Murmurs, 119
    • BENIGN SYSTOLIC MURMURS, 121
      • Origin of the Benign Systolic Murmur, 121
      • Nature of the Benign Systolic Murmur, 121
    • BENIGN EXTRACARDIAC MURMURS, 122
      • Cervical Venous Hum, 122
      • Mammary Souffle, 123
      • Supraclavicular Arterial Bruit, 124
    • STRAIGHT BACK SYNDROME AND PECTUS EXCAVATUM, 124
      • Nature of the Murmur of Straight Back Syndrome and Pectus Excavatum, 125
    • VENTRICULAR SEPTAL DEFECT, 125
      • Origin of the Murmur of Ventricular Septal Defect, 125
      • Nature of the Murmur of Ventricular Septal Defect, 126
      • Additional Findings in Ventricular Septal Defect, 128
      • Differentiating Ventricular Septal Defect from Other Conditions, 128
      • Prognosis, 130
    • MITRAL REGURGITATION, 130
      • Origin and Nature of the Murmur of Mitral Regurgitation, 130
      • Causes of Mitral Regurgitation and Insufficiency, 131
    • TRICUSPID REGURGITATION, 133
      • Origin and Nature of the Murmur of Tricuspid Regurgitation, 133
      • Causes of Tricuspid Regurgitation, 134
    • VALVULAR AORTIC STENOSIS, 134
      • Origin of the Murmur of Aortic Stenosis, 134
      • Nature of the Murmur of Aortic Stenosis, 134
      • Differentiating Aortic Stenosis from Other Conditions, 136
    • MUSCULAR SUBAORTIC STENOSIS, 138
      • Origin of the Murmur of Muscular Subaortic Stenosis, 138
      • Nature of the Murmur of Muscular Subaortic Stenosis, 138
      • Differentiating Subaortic Stenosis from Other Conditions, 138
    • SUPRAVALVULAR AORTIC STENOSIS, 139
      • Origin of the Murmur of Supravalvular Aortic Stenosis, 139
      • Nature of the Murmur of Supravalvular Aortic Stenosis, 139
    • PULMONIC STENOSIS, 140
      • Origin of the Murmur of Pulmonic Stenosis, 140
      • Nature of the Murmur of Pulmonic Stenosis, 141
      • Differentiating the Murmurs of Pulmonic Stenosis, 145
      • Prognosis, 145
    • DILATATION OF THE PULMONARY ARTERY NEAR THE PULMONARY VALVE, 145
      • Origin and Nature of the Murmur of Pulmonary Dilatation, 145
    • ATRIAL SEPTAL DEFECT, 146
      • Origin of the Murmur of Atrial Septal Defect, 146
      • Nature of the Murmur of Atrial Septal Defect, 146
      • Additional Physical Findings in Atrial Septal Defect, 147
      • Differentiating Atrial Septal Defect from Other Conditions, 147
      • Prognosis, 148
    • COARCTATION OF THE AORTA, 148
      • Origin of the Murmur of Coarctation of the Aorta, 148
      • Nature of the Murmur of Coarctation of the Aorta, 148
      • COARCTATION OF THE ABDOMINAL AORTA, 150
  • CHAPTER 12. Diastolic Murmurs 153
    • AORTIC REGURGITATION, 153
      • Nature of the Murmur of Aortic Regurgitation, 154
      • Additional Clinical Features of Aortic Regurgitation, 154
      • Differentiating Aortic Regurgitation from Other Conditions, 156
    • PULMONARY INSUFFICIENCY, 157
      • Nature of the Murmur of Pulmonary Insufficiency, 157
      • Differentiating the Murmurs of Congenital and Hypertensive Pulmonary Insufficiency from Other Murmurs, 159
    • OTHER DIASTOLIC MURMURS, 159
      • Active Rheumatic Carditis, 159
      • Inactive Rheumatic Heart Disease with Significant Mitral Regurgitation, 160
    • MITRAL STENOSIS, 161
      • Causes of Mitral Stenosis, 161
      • Origin of the Murmur of Mitral Stenosis, 161
      • Nature of the Murmur of Mitral Stenosis, 161
    • TRICUSPID STENOSIS, 164
      • Nature of the Murmur of Tricuspid Stenosis, 164
      • Differentiating the Murmur of Tricuspid Stenosis from the Murmur of Mitral Stenosis, 164
  • CHAPTER 13. Continuous Murmurs 165
    • TO-AND-FRO MURMURS, 165
    • PATENT DUCTUS ARTERIOSUS, 166
      • Diagnosis of Patent Ductus Arteriosus, 166
      • Nature of the Murmur of Patent Ductus Arteriosus, 167
      • Additional Physical Findings, 169
      • Differentiating the Murmur of Patent Ductus Arteriosus from Other Murmurs, 171
      • Prognosis, 173
    • PERICARDIAL FRICTION RUB, 173
      • Origin of the Pericardial Friction Rub, 173
      • Nature of the Pericardial Friction Rub, 173
      • Differentiating Pericardial Friction Rub from Other Sounds, 175
    • OTHER CONTINUOUS MURMURS, 175
      • Arteriovenous Fistula, 175
      • Local Arterial Obstruction, 176
  • CHAPTER 14. Surgically Created Shunts and Prosthetic Valves, 177
    • SHUNTS, 177
      • Blalock-Taussig Shunt, 177
      • Other Shunts, 178
    • PROSTHETIC VALVES, 179
      • Bjork-Shiley Tilting Disc Valve, 179
      • St. Jude Bi-Leaflet Valve, 180
      • Porcine (Hancock) Heterograft, 180
      • New Frontiers in Prosthetic Valve Design, 180
    • EVALUATION OF THE POSTOPERATIVE PATIENT, 181
  • CHAPTER 15. Complex Anomalies 183
    • TETRALOGY OF FALLOT, 183
      • Origin of the Murmur of Tetralogy of Fallot, 183
      • Nature of the Murmur of Tetralogy of Fallot, 184
      • Differentiating Tetralogy of Fallot from Other Conditions, 184
        Prognosis, 185
    • PERSISTENT TRUNCUS ARTERIOSUS COMMUNIS, 186
      • Nature of the Defect, 186;
      • Clinical Features of Persistent Truncus Arteriosus, 186;
      • Nature of the Murmur of Persistent Truncus Arteriosus, 186;
      •  Repair of Persistent Truncus Arteriosus, 187;
      • Prognosis, 188
    • ENDOCARDIAL CUSHION DEFECTS, 188;
      • Complete Endocardial Cushion Defect, 188;
      • Incomplete Endocardial Cushion Defect, 191;
      • Prognosis, 193;
    • TRICUSPID VALVE ANOMALIES, 193;
      • Tricuspid Atresia, 193;
      • Prognosis, 195;
    • Ebstein's Anomaly, 195;
      • Prognosis, 196
    • TRANSPOSITION OF THE GREAT ARTERIES, 196;
      • Anatomic Anomalies, 196;
      • Clinical Features, 197;
      • Nature of Heart Sounds and Murmurs in Transposition of the Great Arteries, 198;
      • Prognosis, 198
    • CORRECTED TRANSPOSITION OF THE GREAT ARTERIES, 198;
      • Anatomic Anomalies, 198;
      • Nature of Heart Sounds and Murmurs in Corrected Transposition of the Great Arteries, 199;
      • Prognosis, 200
    • HYPOPLASTIC LEFT HEART SYNDROME, 200;
      • Anatomic Anomalies, 200;
      • Clinical Features of Hypoplastic Left Heart Syndrome, 201;
      • Nature of Heart Sounds and Murmurs in Hypoplastic Left Heart Syndrome, 201;
      • Prognosis, 201
    • TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION, 201;
      • Nature of the Defect, 201;
      • Clinical Features of Total Anomalous Pulmonary Venous Connection, 202;
      • Heart Sounds in Total Anomalous Pulmonary Venous Connection, 202;
      • Prognosis, 202
    • DOUBLE OUTLET RIGHT VENTRICLE, 203
      • Nature of the Defect, 203
      • Clinical Features of Double Outlet Right Ventricle, 203
      • Heart Sounds in Double Outlet Right Ventricle, 203
      • Pulmonary Artery Banding, 205
      • Prognosis, 205
    • ASPLENIA AND POLYSPLENIA, 205
      • Asplenia, 205
      • Polysplenia, 205
  • Glossary, 209
  • Transcript for Supplemental CD, 213
  • Index, 217