Addicudo
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Q54 - A 4-week-old infant has a loud systolic murmur with a systolic thrill; otherwise, the infant appears healthy. There is no cyanosis. The most likely cause of the murmur is
(A) atrial septal defect
(B) coarctation of the aorta
(C) patent ductus arteriosus
(D) tetralogy of Fallot
(E) ventricular septal defect
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| doc2003
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(A) atrial septal defect
loud s1 and wide fixed split of s2
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| ssrpk
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exagerrated s1 or splitting of s2....ths are not murmurs.....!!!
systolic murmurs occur due to some kind of obstrution.......aortic stenosis,IHSS , coarctation of aorta!
no cyanosis??????....anyway i'll go with b!
btw exagerrated S1 occurs in mitral stenosis which is usually accompanied by opening snap!
give the reasoning!
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| Addicudo
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umm ..
Firstly rule out the cyanotic causes ... i.e TOF ...
Now ... Major Clue is systolic murmur with a systolic thrill ...
ASD murmur would be heard in Diastole .... And Coarction would show no Thrill ...
Therefore VSD .... which shows Systolic (Pansystolic Murmur) .. and Systolic Thrill toO !! .. best response ... VSD !
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| ssrpk
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why wud ASD cause a diastolic murmur.......and wht type of????
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| phuluong2k
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ASD causes leftt to right shunt in atria :arrow: increase flow in right atria :arrow: relative stenosis of tricuspic valve :arrow: diastolic murmur
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| ssrpk
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wht does it mean by relative stenosis????
if so then it shud happen even during excercise due to inmc. in venous return!
not sre abt tht.....but i chked out in Mcloed's .....it says th ASD will indeed produce a systolic murmur due to inc. in pulmonary flow tht results in pulmonary HTN; in addition to fixed splitting of S2!
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| phuluong2k
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Yeah it is right, but it lack tricuspic murmur, i pick this on a website
The murmur of an ASD is produced by excessive flow across the pulmonic and tricuspid valves resulting in a systolic murmur at the second left intercostal space and a mid-diastolic murmur over the lower right sternal area.
Note that this is a flow murmur and NOT a murmur due to turbulent flow across the ASD. Flow across the ASD is low velocity and not turbulent and therefore produces no audible murmur itself.
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| ssrpk
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well thnx a lot!
referring back to the q....considering systolic murmur irt's either asd or vsd!
wht exactly is systolic thrill.....i think diagnosis depends on tht point!
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| syeruq
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The answer is VSD as in VSD there is a Systolic thrill with holosystolic murmur at LLSB as well as Diastolic murmur with large shunts and loud P2 with pulmonary hypertension.
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| phuluong2k
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One more thing, i remember this q some where in the qbank
They say thay ASD can't make thrill
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| KEROCHI
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in addition to all your good points.. remember that in this age group MC cause would be VSD!
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