PAINE #PANCE Pearl – Pediatrics


A 3yo girl is brought to your office by her parents for concern of asthma. They state that when she plays with her siblings, she often gets short of breath and needs to stop to rest for a few minutes. She is otherwise healthy and was born at 38 weeks gestation via cesarean section. She has had an uncomplicated past medical history and is up to date on all immunizations.

Physical examination reveals a well-nourished, well-developed girl, who is at 67% for height and 46% for weight for her age. Vital signs are BP-110/68, HR-87, RR-13, O2-100%, and temperature-98.7o. There is no evidence of cyanosis and auscultation findings are below.

  1. Describe what you hear.
  2. What condition is this most suggestive of?
  3. What is the management of this condition?


  1. Continuous, holosystolic, blowing mumur with a faint split S2

2. This type of murmur and the above clinical features are most likely due to a patent ductus arteriosus.

3. After a Doppler echocardiogram has been performed, surgery would be the next step to close this defect. Pharmacologic therapy does not work as well in older infants and children. Transcatheter closure would be the preferred option given the patient’s age.

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