<aside> 📢
Hyperoxia test (Helps to distinguish cardiac from pulmonary causes of cyanosis)
<aside> ❓
What is the next step in management for a newborn with cyanosis that does not improve with 100% O2 and a continuous machine-like murmur on auscultation?
<aside> 💡
Acrocyanosis
Acrocyanosis
Type | Description | Clinical Presentation |
---|---|---|
Vibratory Still's | 🔹 Low pitched vibratory crescendo-decrescendo systolic murmur | |
🔹 Best heard at left lower sternal border | ||
🔹 ↑ While supine | 🔹 Most common innocent murmur | |
Cervical Venous Hum | 🔹 Low pitched crescendo-plateau-decrescendo, continuous | |
🔹 Caused by turbulence in the internal jugular vein | ||
🔹 Best heard over the supra- or infraclavicular area | ||
🔹 **Disappear with neck flexion | ||
🔹 loudest in diastole** | 🔹 Common in children | |
Pulmonary or Aortic Flow | 🔹 Systolic ejection murmurs | |
🔹 Best heard over left upper sternal border | 🔹 Typically benign |
<aside> <img src="/icons/flag_red.svg" alt="/icons/flag_red.svg" width="40px" /> "Red Flags" Indicating Need for Workup
<aside> 💡
In Peds World
<aside> 💡
Rules
Feature | Benign Murmurs | Pathologic Murmurs |
---|---|---|
History | 🔹 Asymptomatic | |
🔹 Normal growth | ||
🔹 No significant family history | 🔹 Infants → poor weight gain respiratory distress difficulty feeding | |
🔹 Older children → exertional fatigue chest pain syncope | ||
🔹 Family history of SCD or CHD | ||
Murmur Characteristics | 🔹 Early or midsystolic | |
🔹 Musical or vibratory | ||
🔹 Grade 1-2 intensity | ||
🔹 Decreases or disappears with standing and Valsalva maneuver | 🔹 Holosystolic or diastolic | |
🔹 Harsh | ||
🔹 Grade ≥3 intensity | ||
🔹 Intensity persists with standing and Valsalva maneuver | ||
Other Findings | 🔹 Normal vital signs | |
🔹 Normal S1 & S2 | ||
🔹 Symmetric pulses | 🔹 Central cyanosis | |
🔹 Loud fixed or single S2 | ||
🔹 Weak femoral pulses | ||
🔹 Hepatomegaly | ||
Management | 🔹 Reassurance | 🔹 ECG and echocardiography |