Does Your Child Need To See A Doctor About Heart Murmur
Any problems with your babys heart are likely to be picked up at birth, when the midwife or paediatrician checks your baby. If problems arent detected then, theyll probably be picked up in checks during your babys first few weeks.
Sometimes heart murmurs are picked up during general check-ups or check-ups for other issues like infections.
Go to a hospital emergency department or call 000 for an ambulance straight away if your child is having trouble breathing, suddenly becomes pale or blue, or youre concerned your child is very unwell.
Characteristics Of The Murmur
Each heart murmur must be analysed in terms of intensity , timing , location, transmission and quality .
A grade 1 murmur is barely audible, grade 2 is soft but easily heard, grade 3 is loud but not accompanied by a thrill, while grade 4 is associated with a thrill. Grade 5 and 6 are very loud murmurs which may be audible with stethoscope partly or completely off the chest.
Most murmurs are systolic and location of a systolic murmur can point toward specific cardiac diagnosis as described in the table below:
|Upper left sternal border
|Pulmonary stenosis , atrial septal defect , innocent pulmonary flow murmur, tetralogy of Fallot , coarctation of the aorta , aortic stenosis , patent ductus arteriosus with pulmonary hypertension
|Upper right sternal border
|Supraclavicular area, ejection systolic, grades 2-3
|Peripheral pulmonary stenosis
|Upper left sternal border, grades 1-2, radiates to axillae and back, usually disappears by 6 months of age
What Are Heart Valves
Your heart is a strong muscle about the size of the palm of your hand. Your body depends on the hearts pumping action to deliver oxygen- and nutrient-rich blood to the bodys cells. When the cells are nourished properly, the body can function normally. Just like an engine makes a car go, the heart keeps your body running. The heart has two pumps separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.
The heart has four chambers 7), two on the right and two on the left:
- Two upper chambers are called atrium . The atria collect blood as it flows into the heart.
- Two lower chambers are called ventricles. The ventricles pump blood out of the heart to the lungs or other parts of the body.
The heart also has four valves that open and close to let blood flow from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart in only one direction when the heart contracts . The four heart valves are:
- Tricuspid valve, located between the right atrium and right ventricle
- Pulmonary or pulmonic valve, between the right ventricle and the pulmonary artery. This artery carries blood from the heart to the lungs.
- Mitral valve, between the left atrium and left ventricle
- Aortic valve, between the left ventricle and the aorta. This aorta carries blood from the heart to the body.
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Location Of Highest Intensity
The location of the highest intensity of a murmur is also important . A murmur caused by aortic stenosis is often best heard at the upper sternal border, usually on the right side. A murmur resulting from pulmonary stenosis is heard best at the upper left sternal border. A murmur caused by a ventricular septal defect or tricuspid valve insufficiency is heard at the lower left sternal border. A murmur resulting from mitral valve regurgitation is best heard at the apex.
Mitral valve regurgitation
What Is A Heart Murmur
The heart is a muscular organ with four chambers. It pumps blood out to the lungs to pick up oxygen, and out through the body to deliver oxygen. Four valves control the flow of blood through the chambers of the heart and out of the heart.
The heartbeat sounds are the sounds of the valves closing. A heart murmur is an extra sound heard when a doctor listens with a stethoscope. This extra sound is created by turbulent blood flow.
A heart murmur in children caused by turbulent blood flow can be either normal or abnormal:
- In normal heart murmurs, the flow can be heard pumping through the heart normally. This normal blood flow is called an innocent, or normal, murmur. More than 66 percent of all children, and approximately 75 percent of all newborns, have normal heart murmurs.
- Abnormal blood flow suggests a structural heart problem or defect, which requires further evaluation.
Normal heart murmurs are usually louder when the child has a cold or fever, and typically disappear by adolescence . However, normal heart murmurs are still associated with a structurally normal heart they do not cause any exercise restrictions or precautions, do not require antibiotics before a dental-cleaning, and do not require further cardiology evaluation.
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Common Innocent Murmurs In Children
Heart murmurs in children are very common. A heart murmur just means a sound. Some heart murmurs are sounds produced by actual defects or abnormalities with the heart. For example, a ventricular septal defect makes a very specific noise as blood travels through the hole. Abnormalities with heart valves like aortic valve stenosis can also produce heart murmurs. As blood flows past the defective valve the turbulent flow can produce a distinctive sound. On the other hand, many heart murmurs are what we call innocent heart murmurs. With an innocent heart murmur, the heart is perfectly normal. The murmur in this case is simply the normal sound that blood is making as it flows through the heart.
There are a number of different innocent heart murmurs. Lets review 3 relatively common innocent heart murmurs found in children.
Causes Of Child Heart Murmur
If an innocent murmur is ruled out, then the swishing sound can arise because of a defect in the heart. One in a hundred children with heart murmur has congenital defects arising in the valves or the major blood vessels. This inherent abnormality alters the pattern of blood flow, creating the characteristic murmur noise. Defects in the septum, separating the valves in the form of improper closure or a hole can cause a heart murmur. Transposed blood vessels also manifest as a heart murmur. Sometimes, these defects could also arise from endocarditis or rheumatic fever, and the doctor evaluates the child completely for the plausible reasons for murmur.
Premature children with heart murmur can have a condition called patent ductus arteriosus . This is a condition in which, the opening between two major blood vessels fail to develop in the foetal stage and is characterized by a heart murmur and poor weight gain. Sometimes, it is the only symptom that the child shows, making it a very critical diagnosis.
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What Are Heart Murmurs In Newborns
Many parents will be surprised to learn that a heart murmur isnt a disease. Rather, it is a symptom of an underlying condition. If your child has a heart murmur, your pediatrician will hear it while listening to your childs heartbeat with a stethoscope.
As the name implies, a heart murmur is an unusual sound produced by the heart in the course of its normal pumping action. Murmurs in children are relatively common and often do not signify any serious problem. The extra sounds might be nothing more than those of normal blood flowing through a healthy heart.
If a murmur is heard at birth, however, or during the first six months of life, your pediatrician might want to pursue further testing to rule out more serious congenital heart defects. Some murmurs are caused by , which occur when the walls separating the left and right sides of the heart have an abnormality that allows blood to mix. Murmurs can also signify underlying blood vessel disease.
A murmur is usually the only symptom of patent ductus arteriosus , a potentially serious condition in which the ductus arteriosus fails to properly close at or shortly after birth. This causes blood to circulate abnormally between two major arteries near the heart.
What Are The Signs And Symptoms Of Heart Murmurs
Usually, there are no visible signs of heart murmur symptoms. The most common way murmurs are diagnosed is during a routine pediatric checkup when your child’s doctor listens to the heart. Innocent murmurs will have no other symptoms.
Murmurs are classified by how loud they are. Louder murmurs are usually more serious than quieter ones.
If your child has an abnormal heart murmur, there may be symptoms that indicate there is an underlying heart condition.
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What Is A Pediatric Heart Murmur
A heart murmur is an extra sound made by the heart during a normal heartbeat. It can be heard listening to your heart using a stethoscope, and sounds like a rushing noise, like the sound of water coming through a hose.
Murmurs are diagnosed as either being innocent or abnormal, with the vast majority being innocent or benign. A child with a heart murmur can have a perfectly healthy heart.
What Are Heart Murmurs In Children
Heart murmurs are extra or abnormal sounds made by turbulent blood flowing through the heart. Murmurs are graded on a scale of 1 to 6, based on how loud they are. One means a very faint murmur. Six means a murmur that’s very loud.
Types of murmurs include:
Systolic murmur. A heart murmur that occurs when the heart contracts.
Diastolic murmur. A heart murmur that occurs when the heart relaxes.
Continuous murmur. A heart murmur that occurs throughout. the heartbeat.
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Are Heart Murmurs Signs Of Something Else
Mild heart murmurs, usually, do not signify anything abnormal. However, some cases can indicate a vessel or valve problem in the heart. Some children who show symptoms like a blue colouration of skin, feeding and breathing difficulties also exhibit heart murmur as a symptom of blood mixing due to cyanotic heart disease. A complete evaluation is usually done by the physician if he suspects any abnormality.
Testing And Diagnosis Of Heart Murmur In Children
Doctors can evaluate many characteristics of the murmur to determine if it is normal or abnormal, including:
- If it is loud or soft
- If it is high- or low-pitched
- Where on the chest or back it can be heard
- If there are differences in the sound based on your child’s position
- When the murmur occurs relative to the first and second heart sounds
If your child’s primary doctor thinks that the murmur is normal or innocent, he or she will note the murmur on the patient chart and listen again at later checkups for changes. If you switch doctors, make sure to tell the new doctor about the innocent murmur. If your child’s doctor feels comfortable that the murmur is normal, there is no need for further cardiology evaluation.
Sometimes the doctor will be concerned that the murmur is not normal. In these cases, you may be referred to a pediatric cardiologist, a doctor who specializes in heart problems in children. It is very important to see the pediatric cardiologist if your child’s doctor tells you to do so.
A pediatric cardiologist will perform a full evaluation of your child’s health, including getting a history and performing an examination, as well as possibly ordering heart tests such as:
- Electrocardiogram: a record of the electrical activity of the heart
- Echocardiogram : sound waves create an image of the heart
- A chest X-ray
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Position Changes In The Differentiation Of Murmurs
Position changes are very helpful in differentiating functional and pathologic murmurs. The vibratory functional murmur heard in a young child decreases in intensity when the patient stands.
Most pathologic murmurs do not change significantly with standing. An important exception is the murmur of hypertrophic cardiomyopathy, a potentially life-threatening condition. This murmur increases in intensity when the patient stands. In the upright position, venous return to the heart is reduced, decreasing the left ventricular end diastolic volume. As left ventricular size decreases, the left ventricular outflow tract narrows, and the systolic outflow obstruction increases. This narrowing increases the intensity of the murmur. Overall, hypertrophic cardiomyopathy is rare however, it is one of the leading causes of sudden death in athletes.6
Diagnosing A Heart Murmur In Your Child
If your childs pediatrician detects a heart murmur, theyll need to listen to the heart for loudness, timing and location of the murmur. This can help determine whether its an innocent or more serious murmur.
During the exam, your childs pediatrician may look for answers to the following questions:
- Does the murmur happen when the heart is contracting or resting?
- Does it change when your child moves?
- Does it last throughout the heartbeat?
- Where is the murmur heard the loudest?
- Can it be heard in the neck, on the back or other parts of the chest?
Harmless heart murmurs dont require treatment. However, your childs pediatrician may refer your child to a pediatric cardiologist if its clear your child has a more serious condition. Your childs pediatric cardiologist may do tests to identify heart rhythms or structural problems and to see how well your childs heart works.
These tests may include the following:
- Chest X-ray: To identify an enlarged heart
- Electrocardiogram : A painless test that measures the electrical activity of your childs heartbeat
- Echocardiogram: Creates pictures of your childs heart using high-frequency soundwaves or ultrasound
If the results of these tests indicate a more serious condition, your childs cardiologist will work with you and your child to create a personalized treatment plan.
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Heart Murmur: What To Expect If Your Child Is Diagnosed
Heart murmurs in children are very common. As many as half of all children will have a heart murmur at some point before 18 years of age. It is important to understand what causes a heart murmur and what needs to be done to evaluate them.
What Is a Heart Murmur?
Every time the heart beats, two normal sounds are generated that can be heard using a stethoscope. A heart murmur is an extra sound that is created by the sound of blood flowing through the heart. The most common heart murmur is caused by normal blood flowing through the heart. These innocent murmurs can be heard at any time throughout childhood and are frequently heard for the first time if a child has an illness, especially if associated with a fever.
Innocent murmurs may simply diagnosed with a health care provider listening to your childs heart or may involve other testing, such as an electrocardiogram or echocardiogram. Innocent murmurs do not affect your childs health and will not affect his or her development. A child with an innocent murmur will have no restrictions and will not need to be followed by a pediatric cardiologist. If your pediatrician or care provider isnt sure what is causing the murmur they may refer you to a pediatric cardiologist to evaluate your childs murmur.
What to Expect from the Pediatric Cardiologist or Pediatric Cardiology Nurse Practitioner?
For more information about the Heart Center at Nationwide Children’s Hospital, .