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(16) Atrial septal defect
(17) Ventricular septal defect
(18) Pulmonary stenosis
At P, an ejection murmur can be heard during early
systole. Also, a fixed break-up II sound that does not
change from breathing can be heard. This is
relatively often seen in inherent heart disorders. In
children, it is necessary to distinguish this from
harmless murmur.
At T, mainly at this point, a large rough murmur
accompanied by trilling can be heard during all
systolic periods.
This is commonly seen among congenital heart
disorders, but the smaller the pathway from the left
ventricle to the right ventricle is, the larger the
murmur heard. (Levine 3/6, 4/6)
At P, an ejection murmur can be heard during late
systole. It is sometimes combined with congenital
heart disorders such as Tetralogy of Fallot. It
accompanies zyanose, and the child's growth is
defective.
Occasionally, only valvular stenosis is observed, the
growth is normal, and it may be mistaken as
harmless murmur.