An asymptomatic 2-year-old is referred for evaluation of a soft continuous murmur below the right clavicle that becomes louder when the child sits upright and disappears completely when lying supine. Peripheral pulses are normal and there is no wide pulse pressure. The MOST appropriate next step is:
- A Echocardiography to exclude patent ductus arteriosus before discharge
- B Cardiac catheterisation to measure Qp:Qs ratio
- C Reassurance, as this is a benign venous hum requiring no intervention ✓
- D Prophylactic antibiotics against infective endocarditis
Correct answer: C. Reassurance, as this is a benign venous hum requiring no intervention
Explanation
Venous hum is a benign continuous murmur produced by turbulent flow in the internal jugular veins. It is best heard below the right clavicle, characteristically louder in the sitting position, softer or abolished when supine, and eliminated by gentle jugular vein compression or turning the head. Normal pulses and absence of a wide pulse pressure exclude PDA, so echocardiography and catheterisation are unnecessary, and IE prophylaxis is never indicated for innocent murmurs.
Reference: Park's Pediatric Cardiology for Practitioners, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.