As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure.
Today we have some notes from a lecture by a paeds cardiologist at a recent national EM training day.
Murmurs in babies
- mostly VSD and ASD
- mostly picked up antenatally these days
- TGA is the one often missed antenatally
- poor feeding is the hallmark sign (as it seems to be of all bad things in neonates). If feeding alright then the murmur is unlikely to be a big problem
- 92% of those with coarctation will have lost femoral pulses at 5 days (afraid I don’t have a reference for this). Which means some femoral pulses will be normal at discharge
- less than a 20 mmhg difference between the upper and lower limbs is reassuring that there is no coarct
- in his cardiology clinic they are trying to move away from echo for everyone (see the 2014 appropriate use guidelines for this)
- recommended murmurlab.com and the pediatric ECG stat app