Pediatric Cardiology

THE DISCUSSION of cardiac problems included: a consideration of functional murmurs; rheumatic fever; heart failure in infancy; and congenital cardiac malformations with respect to indications for surgery and results. FUNCTIONAL MURMURS Functional or innocent murmurs are always systolic in time. Occasionally a functional murmur may be heard in the pulmonic area, and must be differentiated from an organic murmur due to a small atrial secundum defect. However, the most common functional murmur is that heard between the apex and lower left sternal border. The quality best suggests the adjective "vibratory," but other tennis frequently used are "groaning," "musical" or "twanging string." This murmur, which is of moderate duration, can be extremely loud and frequently is intensified by exercise. A venous hum, which is a continuous bruit throughout systole and diastole, is a common finding that has no pathologic significance. With the patient in the erect position it is audible below the clavicles and is best heard in the neck. The diastolic component may be transmitted downwards and occasionally suggests the murmur of aortic insufficiency. However, in the case of a venous hum, the diastolic bruit can usually be obliterated by compressing the neck vessels, which cannot be done when the murmur is due to aortic insufficiency. The continuous murmur of a venous hum must on occasion be differentiated from that due to a patent ductus arteriosus, but it should always be noted that time murmur of a patent ductus is loudest when the patient is in the supine position.