Baby with cardiac murmur

Masculine, Asian, baby 11 Months old, natural from Santo André – São Paulo – Brazil.. Positive history of murmur diagnosis from two Months of his life.
Antecedent of two episodes of past pneumony during four and eight Months of his life. His mother refers profuse sweat with the suction and easy fatigability.

Physical
increased right ventricular impulse, evidence of mitral incompetence: palpable thrill in apical region and holosystolic murmur of mitral insufficiency is high-pitched, and loudest at the apex radiated to the sternal edge.

The first heart sound is faint.
A systolic ejection murmur is heard loudest at the upper left sternal border, following by a second heart sound widely fixed splitting.

A tricuspid mid-diastolic rumble is appreciated at the lower left sternal border.