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Keyword Heart Murmurs in Children
Search Urlhttps://www.google.com/search?q=Heart+Murmurs+in+Children&oq=Heart+Murmurs+in+Children&num=30&hl=en&gl=US&sourceid=chrome&ie=UTF-8
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what is a heart murmur in babieshttps://www.google.com/search?num=30&hl=en&gl=us&q=What+is+a+heart+murmur+in+babies&sa=X&ved=2ahUKEwjg9amf77D1AhXxrHIEHeMhCqoQ1QJ6BAguEAE
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Result 1
TitleHeart Murmurs (for Parents) - Nemours KidsHealth
Urlhttps://kidshealth.org/en/parents/murmurs.html
DescriptionHeart murmurs are very common, and most are no cause for concern and won't affect a child's health
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H1Heart Murmurs
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H3What Are Heart Murmurs?
What Happens in a Heart Murmur?
Who Gets Heart Murmurs?
How Are Heart Murmurs Diagnosed?
What Causes Heart Murmurs?
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BodyHeart Murmurs Reviewed by: Steven B. Ritz, MD, MSEd Cardiology (Heart Care) at Nemours Children's Health Listen Play Stop   Volume   mp3 Settings Close Player Larger text sizeLarge text sizeRegular text size Print en español Los soplos cardíacos y su hijo What Are Heart Murmurs? The human heartbeat is usually steady: lub-dub, lub-dub. In some people, though, the blood makes an extra noise as it flows through the heart. This sound is called a murmur. Doctors hear a heart murmur as a whooshing sound between heartbeats. The whoosh is just an extra noise that the blood makes as it flows through the heart. What Happens in a Heart Murmur? Depending on a person's age, the heart beats about 60 to 120 times every minute. Each heartbeat is really two separate sounds. The heart goes "lub" with the closing of the valves that control blood flow from the upper chambers to the lower chambers. Then, as the valves controlling blood going out of the heart close, the heart goes "dub." A heart murmur describes an extra sound heard in addition to the "lub-dub." Sometimes these extra sounds are simply the sound of normal blood flow moving through a normal heart. Other times, a murmur may be a sign of a heart problem. Who Gets Heart Murmurs? Parents might worry if they're told that their child has a heart murmur. But heart murmurs are very common, and many kids are found to have one at some point. Most murmurs are not a cause for concern and won't affect a child's health at all. How Are Heart Murmurs Diagnosed? Doctors listen to the heart by putting a stethoscope on different areas of the chest. It helps if kids are quiet as the doctor listens, because some heart murmurs are very soft. It's not unusual for a murmur to be noticed during a routine checkup, even if none was heard before. Heart murmurs are rated on a scale from 1 to 6 based on how loud they are. Grade 1 is very soft, whereas grade 6 is very loud. If a murmur is found, the doctor may refer a child to a pediatric cardiologist for further evaluation. What Causes Heart Murmurs? Innocent Heart Murmurs. The most common type of heart murmur is called functional or innocent. An innocent heart murmur is the sound of blood moving through a normal, healthy heart in a normal way. Just as you might hear air moving through an air duct or water flowing through a pipe, doctors can hear blood moving through the heart even when there's no heart problem. An innocent heart murmur can come and go throughout childhood. Kids with these murmurs don't need a special diet, restriction of activities, or any other special treatment. Those old enough to understand that they have a heart murmur should be reassured that they aren't any different from other kids. Most innocent murmurs will go away on their own as a child gets older. Congenital Heart Defects. Some murmurs can indicate a problem with the heart. In these cases, doctors will have a child see a pediatric cardiologist. The cardiologist will order tests such as: a chest X-ray: a picture of the heart and surrounding organs an EKG: a record of the heart's electrical activity an echocardiogram: a picture of the heart made using sound waves About 1 out of every 100 babies is born with a structural heart problem, or congenital heart defect. These babies may show signs of the defect as early as the first few days of life or not until later in childhood. Some kids won't have any symptoms beyond a heart murmur, while others will such signs as: rapid breathing difficulty feeding blueness in the lips (called cyanosis) failure to thrive An older child or teen might: be very tired have trouble exercising or doing physical activity have chest pain Call your doctor if your child has any of these symptoms. Pregnant women have a higher risk of having a baby with a heart defect if they get rubella (German measles), have poorly controlled diabetes, or have PKU (phenylketonuria, a genetic error of the body's metabolism). Common Heart Defects. Several kinds of heart problems can cause heart murmurs, including: Septal defects, which involve the walls (or septum) between the upper or lower chambers of the heart. A hole in the septum can let blood flow through it into the heart's other chambers. This extra blood flow may cause a murmur. It can also make the heart work too hard or become enlarged. Bigger holes can cause symptoms besides a heart murmur; smaller ones may eventually close on their own. Valve abnormalities, caused by heart valves that are narrow, too small, too thick, or otherwise abnormal. These valves don't allow smooth blood flow across them. Sometimes, they can allow backflow of blood within the heart. Either problem will cause a murmur. Outflow tract obstruction might be caused by extra tissue or heart muscle that blocks the smooth flow of blood through the heart. Heart muscle disorders (cardiomyopathy), which can make the heart muscle abnormally thick or weak, hurting its ability to pump blood to the body normally. Your doctor and a pediatric cardiologist can determine if the murmur is innocent (which means your child is perfectly healthy) or if there is a specific heart problem. If there is a problem, the pediatric cardiologist will know how best to take care of it. Reviewed by: Steven B. Ritz, MD, MSEd Date reviewed: January 2017 /content/kidshealth/misc/medicalcodes/parents/articles/murmurs
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TitleHeart Murmurs in Children | Cedars-Sinai
Urlhttps://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/h/heart-murmurs-in-children.html
DescriptionHeart murmurs are extra or unusual sounds made by blood moving through the heart. Many children have heart murmurs. Some cause no problems or go away over time. Others require treatment
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H1Heart Murmurs in Children
H2What are heart murmurs in children?
What causes heart murmurs in a child?
What are the symptoms of heart murmurs in a child?
How are heart murmurs diagnosed in a child?
How are heart murmurs treated in a child?
What are possible complications of heart murmurs in a child?
When should I call my child's healthcare provider?
Key points about heart murmurs in children
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H2WithAnchorsWhat are heart murmurs in children?
What causes heart murmurs in a child?
What are the symptoms of heart murmurs in a child?
How are heart murmurs diagnosed in a child?
How are heart murmurs treated in a child?
What are possible complications of heart murmurs in a child?
When should I call my child's healthcare provider?
Key points about heart murmurs in children
Next steps
BodyHeart Murmurs in Children Not what you're looking for? Start New Search ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS 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. What causes heart murmurs in a child? Heart murmurs may be common in normal, healthy children. These are called innocent murmurs. In some cases, a child may be born with a heart defect that causes a murmur. These may be called pathologic. Other causes of murmurs include: Infection Fever Low red blood cell count (anemia) Overactive thyroid gland (hyperthyroidism) Heart valve disease What are the symptoms of heart murmurs in a child? Children with innocent murmurs have no other symptoms except the abnormal heart sounds. A child with a pathologic heart murmur may have one or more of the following symptoms. They vary depending on the problem. Poor feeding, eating, or weight gain Shortness of breath or breathing fast Sweating Chest pain Dizziness or fainting (syncope) Bluish skin, especially of the lips and fingertips Cough Swelling (edema) of the lower legs, ankles, feet, belly (abdomen), liver, or neck veins The symptoms of heart murmur can be like other health conditions. Have your child see his or her healthcare provider for a diagnosis. How are heart murmurs diagnosed in a child? The healthcare provider will ask about your child’s symptoms and health history. He or she will do a physical exam on your child. During an exam, the provider will listen to your child's heart with a stethoscope. If the provider hears an abnormal sound, he or she may refer you to a pediatric cardiologist. This is a doctor with special training to treat children with heart problems. Tests include: Chest X-ray. An X-ray creates images of the heart and lungs. Electrocardiogram (ECG). This test that measures the electrical activity of the heart. Echocardiography (echo). An exam that uses sound waves (ultrasound) to look at the structure and function of the heart. This is the most important test to find heart murmurs. How are heart murmurs treated in a child? Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Many heart murmurs are normal, extra sounds in children with strong, healthy hearts. These children don’t need treatment. Some of these heart murmurs may go away on their own with time. If the murmur is from a congenital heart defect, treatment may include medicine, procedures, or surgery. If the murmur is from another condition, the heart murmur will usually lessen or go away once the condition is treated.   What are possible complications of heart murmurs in a child? . A heart murmur has no complications. But your child may have complications related to the condition causing the heart murmur. A child with a congenital heart defect may have poor growth and development, heart failure, or other serious problems. When should I call my child's healthcare provider? Call your child's healthcare provider if your child has any symptoms of heart disease such as: Trouble feeding or eating Doesn't gain weight normally Trouble breathing Faintness Rapid breathing or blue lips Blue legs or feet Passing out Tiredness or trouble exercising Chest pain Key points about heart murmurs in children. Heart murmurs are extra or unusual sounds made by turbulent blood flowing through the heart. Many heart murmurs are harmless (innocent). Some heart murmurs are caused by congenital heart defects or other conditions. These are called pathologic. If the healthcare provider hears a heart murmur when listening to your child's chest with a stethoscope, he or she may refer you a pediatric cardiologist for more tests. Next steps. Tips to help you get the most from a visit to your child’s healthcare provider: Know the reason for the visit and what you want to happen. Before your visit, write down questions you want answered. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child. Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are. Ask if your child’s condition can be treated in other ways. Know why a test or procedure is recommended and what the results could mean. Know what to expect if your child does not take the medicine or have the test or procedure. If your child has a follow-up appointment, write down the date, time, and purpose for that visit. Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice. Not what you're looking for? Start New Search Want More Information? Cedars-Sinai has a range of comprehensive treatment options. See Our Programs Looking for a Physician? Choose a doctor and schedule an appointment. Find a Doctor Need Help? 1-800-CEDARS-1 (1-800-233-2771) Available 24 Hours A Day Schedule a Callback Expert Care for Life™ Starts Here Adult Primary Care Pediatric Primary Care Urgent Care Need Help? 1-800-CEDARS-1 (1-800-233-2771) Schedule a Callback Looking for a Physician Choose a doctor and schedule an appointment. Find a Doctor Share Email Print
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Result 4
TitleHeart Murmurs in Children - HealthyChildren.org
Urlhttps://www.healthychildren.org/English/health-issues/conditions/heart/Pages/Heart-Murmur.aspx
Descriptionheart~American Academy of Pediatrics reviews information on heart murmurs, which are very common in children. Read on to learn more
DateSep 22, 2020
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TitleHeart Murmur in Children | Causes, Symptoms & Treatment
Urlhttps://www.cincinnatichildrens.org/health/h/murmurs
DescriptionA heart murmur is an extra sound made by the heart. Learn about the types of heart murmurs and view answers to common questions
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TitleHeart Murmur in Children | Children's Hospital of Philadelphia
Urlhttps://www.chop.edu/conditions-diseases/heart-murmur
DescriptionLearn about the different types of heart murmurs in children and how they are diagnosed and treated at our Cardiac Center
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H1Heart Murmur in Children
H2What is a heart murmur?
Testing and diagnosis of heart murmur in children
H3Search
Why Choose Us
Stay in Touch
Four Wheeling
A Thriving Kid
Innovative Treatment Replaces Major Surgery
H2WithAnchorsWhat is a heart murmur?
Testing and diagnosis of heart murmur in children
BodyHeart Murmur in Children Contact Us Cardiac Center 13 Locations Outpatient Appointments 215-590-4040 Second Opinions, Referrals and Information About Our Services 267-426-9600 Contact Us Online 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 (though not always). 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. 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 (also called "echo" or cardiac ultrasound): sound waves create an image of the heart A chest X-ray Not all tests will need to be performed, as pediatric cardiologists are specially trained to tell whether these murmurs are normal or abnormal. Based on your child’s evaluation, doctors will come up with a plan for treating your child. Sometimes, abnormal murmurs don't show up right away, and develop later. Also, there are some heart abnormalities that don't even have murmurs. See our list of symptoms that might indicate a heart problem. If your child has any of them, make sure to tell your primary care doctor. Reviewed by Next Steps Contact Us Cardiac Center 13 Locations Outpatient Appointments 215-590-4040 Second Opinions, Referrals and Information About Our Services 267-426-9600 Contact Us Online Why Choose Us . Our specialists are leading the way in the diagnosis, treatment and research of congenital and acquired heart conditions. Stay in Touch . Subscribe to receive updates on research and treatment, patient stories, profiles of clinicians, news about special events and much more! You Might Also Like Four Wheeling. At age 13, Brett was diagnosed with ARVD. With the help of an implantable cardioverter defibrillator, Brett was able to return to the activities he loved. A Thriving Kid. When Joseph was 4 years old he was diagnosed with a heart arrhythmia. He's now routinely monitored by team members at CHOP — and is thriving. Innovative Treatment Replaces Major Surgery. Mac, 17, was able to receive a newly developed finger-sized device to fix a leaky heart valve, saving him from an open-heart surgery.
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TitleHeart murmurs - Symptoms and causes - Mayo Clinic
Urlhttps://www.mayoclinic.org/diseases-conditions/heart-murmurs/symptoms-causes/syc-20373171
DescriptionThis type of heart murmur is common in newborns and children. An innocent murmur can occur when blood flows more rapidly than normal through the ...
DateOct 24, 2020
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TitleEvaluation and Management of Heart Murmurs in Children - American Family Physician
Urlhttps://www.aafp.org/afp/2011/1001/p793.html
DescriptionHeart murmurs are common in healthy infants, children, and adolescents. Although most are not pathologic, a murmur may be the sole manifestation of serious heart disease. Historical elements that suggest pathology include family history of sudden cardiac death or congenital heart disease, in utero exposure to certain medications or alcohol, maternal diabetes mellitus, history of rheumatic fever or Kawasaki disease, and certain genetic disorders. Physical examination should focus on vital signs; age-appropriate exercise capacity; respiratory or gastrointestinal manifestations of congestive heart failure; and a thorough cardiovascular examination, including features of the murmur, assessment of peripheral perfusion, and auscultation over the heart valves. Red flags that increase the likelihood of a pathologic murmur include a holosystolic or diastolic murmur, grade 3 or higher murmur, harsh quality, an abnormal S2, maximal murmur intensity at the upper left sternal border, a systolic click, or increased intensity when the patient stands. Electrocardiography and chest radiography rarely assist in the diagnosis. Referral to a pediatric cardiologist is recommended for patients with any other abnormal physical examination findings, a history of conditions that increase the likelihood of structural heart disease, symptoms suggesting underlying cardiac disease, or when a specific innocent murmur cannot be identified by the family physician. Echocardiography provides a definitive diagnosis and is recommended for evaluation of any potentially pathologic murmur, and for evaluation of neonatal heart murmurs because these are more likely to be manifestations of structural heart disease
Dateby JE Frank · 2011 · Cited by 103
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H1Evaluation and Management of Heart Murmurs in Children
H2Incidence and Prevalence
History
Physical Examination
Role of Diagnostic Testing
Indications for Referral
Neonatal Heart Murmurs
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REFERENCES
H2WithAnchorsIncidence and Prevalence
History
Physical Examination
Role of Diagnostic Testing
Indications for Referral
Neonatal Heart Murmurs
Continue reading from October 1, 2011
BodyEvaluation and Management of Heart Murmurs in Children  JENNIFER E. FRANK, MD, and KATHRYN M. JACOBE, MD, University of Wisconsin Fox Valley Family Medicine Residency Program, Appleton, WisconsinAm Fam Physician. 2011 Oct 1;84(7):793-800. Abstract Incidence and PrevalenceHistoryPhysical ExaminationRole of Diagnostic TestingIndications for ReferralNeonatal Heart MurmursReferencesArticle Sections. Abstract Incidence and PrevalenceHistoryPhysical ExaminationRole of Diagnostic TestingIndications for ReferralNeonatal Heart MurmursReferencesHeart murmurs are common in healthy infants, children, and adolescents. Although most are not pathologic, a murmur may be the sole manifestation of serious heart disease. Historical elements that suggest pathology include family history of sudden cardiac death or congenital heart disease, in utero exposure to certain medications or alcohol, maternal diabetes mellitus, history of rheumatic fever or Kawasaki disease, and certain genetic disorders. Physical examination should focus on vital signs; age-appropriate exercise capacity; respiratory or gastrointestinal manifestations of congestive heart failure; and a thorough cardiovascular examination, including features of the murmur, assessment of peripheral perfusion, and auscultation over the heart valves. Red flags that increase the likelihood of a pathologic murmur include a holosystolic or diastolic murmur, grade 3 or higher murmur, harsh quality, an abnormal S2, maximal murmur intensity at the upper left sternal border, a systolic click, or increased intensity when the patient stands. Electrocardiography and chest radiography rarely assist in the diagnosis. Referral to a pediatric cardiologist is recommended for patients with any other abnormal physical examination findings, a history of conditions that increase the likelihood of structural heart disease, symptoms suggesting underlying cardiac disease, or when a specific innocent murmur cannot be identified by the family physician. Echocardiography provides a definitive diagnosis and is recommended for evaluation of any potentially pathologic murmur, and for evaluation of neonatal heart murmurs because these are more likely to be manifestations of structural heart disease. Heart murmurs are common in asymptomatic, otherwise healthy children. These murmurs are often innocent and result from the normal patterns of blood flow through the heart and vessels.1 However, a heart murmur may be the sole finding in children with structural heart disease; therefore, a thorough evaluation is necessary.  Enlarge      Print SORT: KEY RECOMMENDATIONS FOR PRACTICE. Clinical recommendationEvidence ratingReferencesStructural heart disease is more likely when the murmur is holosystolic, diastolic, grade 3 or higher, or associated with a systolic click; when it increases in intensity with standing; or when it has a harsh quality.C6, 10, 25Chest radiography and electrocardiography rarely assist in the diagnosis of heart murmurs in children.B5, 6, 29–33Family physicians should order echocardiography or consider referral to a pediatric cardiologist for newborns with a heart murmur, even if the child is asymptomatic, because of the higher prevalence of structural heart lesions in this population.B28, 43A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml.SORT: KEY RECOMMENDATIONS FOR PRACTICE. Clinical recommendationEvidence ratingReferencesStructural heart disease is more likely when the murmur is holosystolic, diastolic, grade 3 or higher, or associated with a systolic click; when it increases in intensity with standing; or when it has a harsh quality.C6, 10, 25Chest radiography and electrocardiography rarely assist in the diagnosis of heart murmurs in children.B5, 6, 29–33Family physicians should order echocardiography or consider referral to a pediatric cardiologist for newborns with a heart murmur, even if the child is asymptomatic, because of the higher prevalence of structural heart lesions in this population.B28, 43A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml.Incidence and Prevalence. Jump to section + Abstract Incidence and PrevalenceHistoryPhysical ExaminationRole of Diagnostic TestingIndications for ReferralNeonatal Heart MurmursReferencesCongenital heart disease (CHD) may occur in the presence or absence of a heart murmur. The incidence of CHD varies between four and 50 per 1,000 live births.2 One review found an incidence of 75 cases per 1,000 live births; of these, six cases per 1,000 were moderate or severe.3History. Jump to section + Abstract Incidence and PrevalenceHistoryPhysical ExaminationRole of Diagnostic TestingIndications for ReferralNeonatal Heart MurmursReferencesCertain historical features suggest possible structural heart disease (Table 1).1,2,4–11  Cardiovascular signs and symptoms can be non-specific (e.g., poor feeding, failure to thrive) or specific (e.g., chest pain, palpitations), and can help identify children who are likely to have structural heart disease (Table 2).4,7,10  Enlarge      Print Table 1.Historical Findings Suggesting Structural Heart Disease in Children with Heart Murmurs. Historical findingSignificanceFamily historyCHDMore common in children with a first-degree relative who has CHD (three- to 10-fold increased risk7); high penetrance with ventricular septal defect and mitral valve prolapseSudden cardiac death or hypertrophic cardiomyopathyIncreased risk of hypertrophic cardiomyopathy (autosomal dominant pattern)Sudden infant death syndromeCan be secondary to undiagnosed CHD lesions8Personal historyConditions that may coexist with CHD:Certain genetic disorders (e.g., DiGeorge syndrome, velo-cardio-facial syndrome) are associated with cardiac malformationsAneuploidy (e.g., trisomy 21, Turner syndrome)Trisomy 21 is associated with an increased risk of atrioventricular septal defects, atrial septal defects, ventricular septal defects, patent ductus arteriosus, and tetralogy of FallotConnective tissue disorder (e.g., Marfan syndrome)Turner syndrome is associated with increased risk of coarctation of the aorta, aortic valve stenosis, and left ventricular hypertrophyInborn error of metabolismMarfan syndrome is associated with mitral valve prolapse, aortic root dilation, and aortic insufficiencyMajor congenital defects of other organ systemsSyndrome with dysmorphic featuresFrequent respiratory infectionsRespiratory symptoms may be attributable to heart disease (i.e., congestive heart failure); enlarged vessels may lead to atelectasis or difficulty clearing respiratory secretions, thereby promoting infectionKawasaki diseaseLeading cause of acquired cardiac disease in children; can cause coronary artery aneurysm and stenosis9Rheumatic feverAssociated with development of rheumatic heart diseasePrenatal or perinatal historyIn utero exposure to alcohol or other toxinsFetal alcohol syndrome is associated with an increased risk of atrial and ventricular septal defects, and tetralogy of Fallot10In utero exposure to selective serotonin reuptake inhibitors or other potentially teratogenic medicationsSelective serotonin reuptake inhibitor exposure is associated with a small but statistically significant increased risk of mild heart lesions, including ventricular septal defects and bicuspid aortic valve (although not all studies found an increased risk11)Lithium exposure is associated with Ebstein anomaly of the tricuspid valveValproate (Depacon) exposure is associated with coarctation of the aorta and hypoplastic left heart syndromeIntrauterine infectionMaternal infections may increase risk of structural heart lesions (e.g., maternal rubella infection is associated with patent ductus arteriosus and peripheral pulmonary stenosis)Maternal diabetes mellitusIncreased risk of CHD, including transient hypertrophic cardiomyopathy, tetralogy of Fallot, truncus arteriosus, and double-outlet right ventriclePreterm deliveryCHD is associated with other conditions (e.g., genetic disorders, in utero exposure to toxins) that can result in preterm birth; 50 percent of newborns weighing less than 3 lb, 5 oz (1,500 g) at birth have CHD (most commonly patent ductus arteriosus)7CHD = congenital heart disease.Information from references 1, 2, and 4 through 11.Table 1.Historical Findings Suggesting Structural Heart Disease in Children with Heart Murmurs. Historical findingSignificanceFamily historyCHDMore common in children with a first-degree relative who has CHD (three- to 10-fold increased risk7); high penetrance with ventricular septal defect and mitral valve prolapseSudden cardiac death or hypertrophic cardiomyopathyIncreased risk of hypertrophic cardiomyopathy (autosomal dominant pattern)Sudden infant death syndromeCan be secondary to undiagnosed CHD lesions8Personal historyConditions that may coexist with CHD:Certain genetic disorders (e.g., DiGeorge syndrome, velo-cardio-facial syndrome) are associated with cardiac malformationsAneuploidy (e.g., trisomy 21, Turner syndrome)Trisomy 21 is associated with an increased risk of atrioventricular septal defects, atrial septal defects, ventricular septal defects, patent ductus arteriosus, and tetralogy of FallotConnective tissue disorder (e.g., Marfan syndrome)Turner syndrome is associated with increased risk of coarctation of the aorta, aortic valve stenosis, and left ventricular hypertrophyInborn error of metabolismMarfan syndrome is associated with mitral valve prolapse, aortic root dilation, and aortic insufficiencyMajor congenital defects of other organ systemsSyndrome with dysmorphic featuresFrequent respiratory infectionsRespiratory symptoms may be attributable to heart disease (i.e., congestive heart failure); enlarged vessels may lead to atelectasis or difficulty clearing respiratory secretions, thereby promoting infectionKawasaki diseaseLeading cause of acquired cardiac disease in children; can cause coronary artery aneurysm and stenosis9Rheumatic feverAssociated with development of rheumatic heart diseasePrenatal or perinatal historyIn utero exposure to alcohol or other toxinsFetal alcohol syndrome is associated with an increased risk of atrial and ventricular septal defects, and tetralogy of Fallot10In utero exposure to selective serotonin reuptake inhibitors or other potentially teratogenic medicationsSelective serotonin reuptake inhibitor exposure is associated with a small but statistically significant increased risk of mild heart lesions, including ventricular septal defects and bicuspid aortic valve (although not all studies found an increased risk11)Lithium exposure is associated with Ebstein anomaly of the tricuspid valveValproate (Depacon) exposure is associated with coarctation of the aorta and hypoplastic left heart syndromeIntrauterine infectionMaternal infections may increase risk of structural heart lesions (e.g., maternal rubella infection is associated with patent ductus arteriosus and peripheral pulmonary stenosis)Maternal diabetes mellitusIncreased risk of CHD, including transient hypertrophic cardiomyopathy, tetralogy of Fallot, truncus arteriosus, and double-outlet right ventriclePreterm deliveryCHD is associated with other conditions (e.g., genetic disorders, in utero exposure to toxins) that can result in preterm birth; 50 percent of newborns weighing less than 3 lb, 5 oz (1,500 g) at birth have CHD (most commonly patent ductus arteriosus)7CHD = congenital heart disease.Information from references 1, 2, and 4 through 11.  Enlarge      Print Table 2.Symptoms Suggesting Cardiac Disease. Symptom or signSignificanceCardiovascularChest painMay be related to aortic stenosis or hypertrophic cardiomyopathyCyanosisStructural heart lesion with restricted pulmonary blood flowDizzinessMultiple potential causes, including hypoxia and CHFNear-syncope or syncopeMay be related to aortic stenosis or hypertrophic cardiomyopathyPalpitationsMay be related to arrhythmias secondary to structural heart lesionsConstitutionalDevelopmental delayCongenital heart lesions are more common in children with certain genetic disorders and syndromesDiaphoresisMay indicate CHF or poor cardiac fitnessEasily fatiguedMay indicate CHF, hypoxia, or poor cardiac fitnessPoor exercise tolerance or capacity for playMay indicate CHF, hypoxia, or poor cardiac fitnessPoor growth or failure to thriveMay indicate CHF, poor cardiac fitness, or a genetic disorder or syndrome; poor weight gain most commonly reflects decreased cardiac output or left-to-right shunts with pulmonary hypertensionRespiratoryAsthma-like symptomsCardiac asthma resulting from pulmonary congestionChronic coughAtelectasis or difficulty clearing secretions because of pulmonary vascular congestionDyspnea on exertionMay indicate CHF, hypoxia, or poor cardiac fitnessCHF = congestive heart failure.Information from references 4, 7, and 10.Table 2.Symptoms Suggesting Cardiac Disease. Symptom or signSignificanceCardiovascularChest painMay be related to aortic stenosis or hypertrophic cardiomyopathyCyanosisStructural heart lesion with restricted pulmonary blood flowDizzinessMultiple potential causes, including hypoxia and CHFNear-syncope or syncopeMay be related to aortic stenosis or hypertrophic cardiomyopathyPalpitationsMay be related to arrhythmias secondary to structural heart lesionsConstitutionalDevelopmental delayCongenital heart lesions are more common in children with certain genetic disorders and syndromesDiaphoresisMay indicate CHF or poor cardiac fitnessEasily fatiguedMay indicate CHF, hypoxia, or poor cardiac fitnessPoor exercise tolerance or capacity for playMay indicate CHF, hypoxia, or poor cardiac fitnessPoor growth or failure to thriveMay indicate CHF, poor cardiac fitness, or a genetic disorder or syndrome; poor weight gain most commonly reflects decreased cardiac output or left-to-right shunts with pulmonary hypertensionRespiratoryAsthma-like symptomsCardiac asthma resulting from pulmonary congestionChronic coughAtelectasis or difficulty clearing secretions because of pulmonary vascular congestionDyspnea on exertionMay indicate CHF, hypoxia, or poor cardiac fitnessCHF = congestive heart failure.Information from references 4, 7, and 10.In infants, feeding difficulties may be the first sign of congestive heart failure, which is present in approximately one-third of infants and children with CHD.4 The most common symptoms in a series of children presenting to the emergency department with acute heart failure included dyspnea (74 percent), nausea and vomiting (60 percent), fatigue (56 percent), and cough (40 percent).12Exercise tolerance should be assessed in an age-appropriate fashion. Parents of infants should be asked about their child's ability to play and the duration and vigor of feeding; parents of older children should compare their child's ability to participate in team sports with that of peers.4 Chest pain is rarely a presenting symptom of cardiac disease in children.13,14 In a pediatric cardiology clinic, chest pain or syncope prompted consultation in approximately 10 percent of children; only 11 percent of those with chest pain and 5 percent of those with syncope had cardiac disease.14 A high degree of suspicion is necessary to detect underlying cardiac disease in children who report exertional syncope or chest pain, or who have a family history of hypertrophic cardiomyopathy.1,13,14Physical Examination. Jump to section + Abstract Incidence and PrevalenceHistoryPhysical ExaminationRole of Diagnostic TestingIndications for ReferralNeonatal Heart MurmursReferencesThe patient's vital signs should be compared with age-established norms (available at http://www.cc.nih.gov/ccc/pedweb/pedsstaff/age.html), and a focused examination of the respiratory, cardiovascular, and gastrointestinal systems should be performed5  (Table 32,5–7,10,15,16). Congenital anomalies of other organ systems may be associated with CHD in up to 25 percent of patients.6 The child's appearance, activity level, color, and respiratory effort should be assessed, and the neck should be examined for prominent vessels, abnormal pulsations, and bruits.1 Jugular venous distension is rare in children.4 The chest wall should be inspected for abnormalities of the sternum, which can be associated with CHD,15 and for abnormal cardiac impulses or thrills.1 The lungs should be auscultated for abnormal breath sounds such as crackles, which may indicate pulmonary congestion, or wheezing, which may indicate cardiac asthma. Abdominal examination should focus on the liver location (seeking abdominal situs) and evaluation for liver enlargement or ascites, which may signal congestive heart failure.5  Enlarge      Print Table 3.Physical Examination of Children with Heart Murmurs. FindingSignificanceAbnormal growth (height and weight plotted on growth chart)Feeding difficulties may be a sign of cardiac disease in newborns and infants (decreased exercise capacity)Certain genetic disorders may increase risk of delayed growth and CHDAbnormal vital signs (compared with age-adjusted norms)Arrhythmia, tachycardia, hypoxia, and tachypnea may indicate underlying structural heart diseaseBlood pressure discrepancy between upper and lower limbs may indicate coarctation of the aorta (pressure gradient of > 20 mm Hg with low blood pressure in the lower extremities)Adventitial breath sounds (e.g., wheezing, rales, ronchi, pleural rub)Wheezing may be associated with cardiac asthma; rales may be associated with pulmonary congestion secondary to congestive heart failureChest contour signaling maldevelopment of the sternum15Defective segmentation of the sternum may occur in children with CHDDysmorphic featuresCertain genetic or congenital conditions increase risk of CHDCardiovascular findingsAbnormal S2Classic finding of wide split fixed S2 with atrial septal defects; abnormal S2 may be present in other types of CHDCapillary refillNormal peripheral perfusion is less than 2 to 3 seconds; delay may indicate poor perfusion secondary to diminished cardiac outputDisplaced point of maximal impulse; precordial impulses (heaves, lifts, thrills)Possible structural abnormality or ventricular enlargementEdemaCongestive heart failureLeft-sided precordial bulgeCardiac enlargementS3 or S4Can indicate structural heart disease; S3 can be a normal finding but usually disappears when patient is uprightSubsternal heaveRight ventricular hypertensionSystolic ejection clickSemilunar valvular stenosisWeak or absent femoral pulsesCoarctation of the aortaGastrointestinal findingsAscitesCongestive heart failureHepatomegalyCongestive heart failureLocation of liver signals abdominal situsHigh rate of CHD with abdominal situsCHD = congenital heart disease.Information from references 2, 5 through 7, 10, 15, and 16.Table 3.Physical Examination of Children with Heart Murmurs. FindingSignificanceAbnormal growth (height and weight plotted on growth chart)Feeding difficulties may be a sign of cardiac disease in newborns and infants (decreased exercise capacity)Certain genetic disorders may increase risk of delayed growth and CHDAbnormal vital signs (compared with age-adjusted norms)Arrhythmia, tachycardia, hypoxia, and tachypnea may indicate underlying structural heart diseaseBlood pressure discrepancy between upper and lower limbs may indicate coarctation of the aorta (pressure gradient of > 20 mm Hg with low blood pressure in the lower extremities)Adventitial breath sounds (e.g., wheezing, rales, ronchi, pleural rub)Wheezing may be associated with cardiac asthma; rales may be associated with pulmonary congestion secondary to congestive heart failureChest contour signaling maldevelopment of the sternum15Defective segmentation of the sternum may occur in children with CHDDysmorphic featuresCertain genetic or congenital conditions increase risk of CHDCardiovascular findingsAbnormal S2Classic finding of wide split fixed S2 with atrial septal defects; abnormal S2 may be present in other types of CHDCapillary refillNormal peripheral perfusion is less than 2 to 3 seconds; delay may indicate poor perfusion secondary to diminished cardiac outputDisplaced point of maximal impulse; precordial impulses (heaves, lifts, thrills)Possible structural abnormality or ventricular enlargementEdemaCongestive heart failureLeft-sided precordial bulgeCardiac enlargementS3 or S4Can indicate structural heart disease; S3 can be a normal finding but usually disappears when patient is uprightSubsternal heaveRight ventricular hypertensionSystolic ejection clickSemilunar valvular stenosisWeak or absent femoral pulsesCoarctation of the aortaGastrointestinal findingsAscitesCongestive heart failureHepatomegalyCongestive heart failureLocation of liver signals abdominal situsHigh rate of CHD with abdominal situsCHD = congenital heart disease.Information from references 2, 5 through 7, 10, 15, and 16.The peripheral pulses should be examined for rate, rhythm, volume, and character, and capillary refill time should be less than three seconds.4 The heart should be auscultated over the tricuspid, pulmonary, mitral, and aortic areas with the bell and diaphragm of the stethoscope while the patient is supine, sitting, and standing17 (Figure 118).Innocent murmurs are produced by the normal flow of blood through the heart. Changing the flow by changing the patient's position (for example, decreasing flow to the heart with the Valsalva maneuver) will change the intensity of the murmur. Young children should be prompted to push out their abdomen against the examiner's hand.1 The physician should listen for normal S1 and S2; a wide fixed split S2 is characteristic of an atrial septal defect.19 Gallops can be a normal finding in adolescents.1  Enlarge      Print Figure 1.Listening areas for clicks: upper right sternal border (URSB) for aortic valve clicks; upper left sternal border (ULSB) for pulmonary valve clicks; lower left sternal border (LLSB), or the tricuspid area, for ventricular septal defects; and the apex for aortic or mitral valve clicks.Reprinted with permission from McConnell ME, Adkins SB III, Hannon DW. Heart murmurs in pediatric patients: when do you refer? Am Fam Physician. 1999;60(2):560.Figure 1.Listening areas for clicks: upper right sternal border (URSB) for aortic valve clicks; upper left sternal border (ULSB) for pulmonary valve clicks; lower left sternal border (LLSB), or the tricuspid area, for ventricular septal defects; and the apex for aortic or mitral valve clicks.Reprinted with permission from McConnell ME, Adkins SB III, Hannon DW. Heart murmurs in pediatric patients: when do you refer? Am Fam Physician. 1999;60(2):560.The heart murmur is characterized by its timing during the cardiac cycle; its location, quality, intensity, and pitch (how it sounds); and the presence or absence of clicks1  (Table 4 5,7,17  and Table 5 20–23). The intensity of heart murmurs is graded from 1 to 6. Grade 1 murmurs are barely audible; grade 2 murmurs are faint but can be heard immediately; grade 3 murmurs can be heard easily and are moderately loud; grade 4 murmurs can be heard easily over a wide area but do not have a palpable thrill; grade 5 murmurs are loud and have a precordial thrill; and grade 6 murmurs are loud enough to hear with the stethoscope raised off the chest.17,24 Certain characteristics of the murmur may be considered red flags, prompting stronger consideration for structural heart disease. These include a holosystolic murmur (odds ratio [OR] of pathologic murmur = 54), grade 3 or higher (OR = 4.8), harsh quality (OR = 2.4), an abnormal S2 (OR = 4.1), maximal intensity at the upper left sternal border (OR = 4.2), a systolic click (OR = 8.3), diastolic murmur, or increased murmur intensity with standing.6,10,25 A decrease or lack of change in the murmur intensity with passive leg elevation (likelihood ratio [LR] = 8.0) or when the child moves from standing to squatting (LR = 4.5) increases the likelihood of hypertrophic cardiomyopathy.26  Enlarge      Print Table 4.Characteristics of Innocent Heart Murmurs. TypeDescriptionAge at detectionCan sound likeAortic systolic murmurSystolic ejection murmur best heard over the aortic valveOlder childhood into adulthood—Mammary artery soufflé*High-pitched systolic murmur that can extend into diastole; best heard along the anterior chest wall over the breastRare in adolescenceArteriovenous anastomoses or patent ductus arteriosusPeripheral pulmonary stenosisGrade 1 or 2, low-pitched, early- to mid-systolic ejection murmur heard over axilla or back< 1 yearPulmonary artery stenosis or normal breath soundsPulmonary flow murmurGrade 2 or 3, crescendo-decrescendo, early- to mid-systolic murmur peaking in mid-systole; best heard at the left sternal border between the second and third intercostal spaces; characterized by a rough, dissonant quality; loudest when patient is supine and decreases when patient is upright and holding breathAllAtrial septal defect or pulmonary valve stenosisStill murmurGrade 1 to 3, early systolic murmur; low to medium pitch with a vibratory or musical quality; best heard at lower left sternal border; loudest when patient is supine and decreases when patient standsInfancy to adolescence, often 2 to 6 yearsVentricular septal defect or hypertrophic cardiomyopathySupraclavicular\brachiocephalic systolic murmurBrief, low-pitched, crescendo-decrescendo murmur heard in the first two-thirds of systole; best heard above clavicles; radiates to neck; diminishes when patient hyperextends shouldersChildhood to young adulthoodBicuspid/stenotic aortic valve, pulmonary valve stenosis, or coarctation of the aortaVenous humGrade 1 to 6 continuous murmur; accentuated in diastole; has a whining, roaring, or whirring quality; best heard over low anterior neck, lateral to the sternocleinomastoid; louder on right; resolves or changes when patient is supine3 to 8 yearsCervical arteriovenous fistulas or patent ductus arteriosus*—Mammary artery soufflé murmur is caused by blood flow in the arteries and veins leading to and from the breasts.Information from references 5, 7, and 17.Table 4.Characteristics of Innocent Heart Murmurs. TypeDescriptionAge at detectionCan sound likeAortic systolic murmurSystolic ejection murmur best heard over the aortic valveOlder childhood into adulthood—Mammary artery soufflé*High-pitched systolic murmur that can extend into diastole; best heard along the anterior chest wall over the breastRare in adolescenceArteriovenous anastomoses or patent ductus arteriosusPeripheral pulmonary stenosisGrade 1 or 2, low-pitched, early- to mid-systolic ejection murmur heard over axilla or back< 1 yearPulmonary artery stenosis or normal breath soundsPulmonary flow murmurGrade 2 or 3, crescendo-decrescendo, early- to mid-systolic murmur peaking in mid-systole; best heard at the left sternal border between the second and third intercostal spaces; characterized by a rough, dissonant quality; loudest when patient is supine and decreases when patient is upright and holding breathAllAtrial septal defect or pulmonary valve stenosisStill murmurGrade 1 to 3, early systolic murmur; low to medium pitch with a vibratory or musical quality; best heard at lower left sternal border; loudest when patient is supine and decreases when patient standsInfancy to adolescence, often 2 to 6 yearsVentricular septal defect or hypertrophic cardiomyopathySupraclavicular\brachiocephalic systolic murmurBrief, low-pitched, crescendo-decrescendo murmur heard in the first two-thirds of systole; best heard above clavicles; radiates to neck; diminishes when patient hyperextends shouldersChildhood to young adulthoodBicuspid/stenotic aortic valve, pulmonary valve stenosis, or coarctation of the aortaVenous humGrade 1 to 6 continuous murmur; accentuated in diastole; has a whining, roaring, or whirring quality; best heard over low anterior neck, lateral to the sternocleinomastoid; louder on right; resolves or changes when patient is supine3 to 8 yearsCervical arteriovenous fistulas or patent ductus arteriosus*—Mammary artery soufflé murmur is caused by blood flow in the arteries and veins leading to and from the breasts.Information from references 5, 7, and 17.  Enlarge      Print Table 5.Prevalence and Characteristics of Pathologic Heart Murmurs. Type of structural heart lesionPrevalence among children with congenital heart disease (%)Symptoms and clinical courseCharacteristicsVentricular septal defect20 to 25Small defects: usually asymptomaticSmall defects: loud holosystolic murmur at LLSB (may not last throughout systole if defect is very small)Medium or large defects: CHF, symptoms of bronchial obstruction, frequent respiratory infectionsMedium and large defects: increased right-to-left ventricular impulses; thrill at LLSB; split or loud single S2; holosystolic murmur at LLSB without radiation; grade 2 to 5; may also hear a grade 1 or 2 mid-diastolic rumbleAtrial septal defect8 to 13Usually asymptomatic and incidentally found on physical examination or echocardiography; large defects can be present in infants with CHFGrade 2 or 3 systolic ejection murmur best heard at ULSB; wide split fixed S2; absent thrill; may have a grade 1 or 2 diastolic flow rumble at LLSBPatent ductus arteriosus6 to 11May be asymptomatic; can cause easy fatigue, CHF, and respiratory symptomsContinuous murmur (grade 1 to 5) in ULSB (crescendo in systole and decrescendo into diastole); normal S1; S2 may be “buried” in the murmur; thrill or hyperdynamic left ventricular impulse may be presentTetralogy of Fallot10Onset depends on severity of pulmonary stenosis; cyanosis may appear in infancy (2 to 6 months of age) or in childhood; other symptoms include hypercyanotic spells or decreased exercise toleranceCentral cyanosis; clubbing of nail beds; grade 3 or 4 long systolic ejection murmur heard at ULSB; may have holosystolic murmur at LLSB; systolic thrill at ULSB; normal to slightly increased S1; single S2Pulmonary stenosis7.5 to 9Usually asymptomatic but may have symptoms secondary to pulmonary congestionSystolic ejection murmur (grade 2 to 5); heard best at ULSB radiating to infraclavicular regions, axillae, and back; normal or loud S1; variable S2; systolic ejection click may be heard at left sternal border and may vary with respirationCoarctation of the aorta5.1 to 8.1Newborns and infants may present with CHF; older children are usually asymptomatic or may have leg pain or weaknessSystolic ejection murmur best heard over interscapular region; normal S1 and S2; decreased or delayed femoral pulse; may have increased left ventricular impulseAortic stenosis5 to 6Usually asymptomatic; symptoms may include dyspnea, easy fatigue, chest pain, or syncope; newborns and infants may present with CHFSystolic ejection murmur (grade 2 to 5) best heard at upper right sternal border with radiation to carotid arteries; left ventricular heave; thrill at ULSB or suprasternal notchTransposition of the great arteries5Variable presentation depending on type; may include cyanosis or CHF in first week of lifeCyanosis; clubbing of nail beds; single S2; murmur may be absent or grade 1 or 2 nonspecific systolic ejection murmur; may have a grade 3 or 4 holosystolic murmur at LLSB and mid-diastolic murmur at apexTotal anomalous pulmonary venous connection2 to 3Onset of CHF at 4 to 6 weeks of ageGrade 2 or 3 systolic ejection murmur at ULSB; grade 1 or 2 mid-diastolic flow rumble at LLSB; wide split fixed S2Tricuspid atresia1.4Early-onset cyanosis or CHF within the first month of lifeCyanosis; clubbing of nail beds; normal pulses; single S2; holosystolic murmur at LLSB or midsternal border; murmur may be absent; mid-diastolic flow murmur at apex may be presentHypoplastic left heart syndromeRareMay be asymptomatic at birth, with cyanosis and CHF developing with duct closureHyperdynamic precordium; single S2; nonspecific grade 1 or 2 systolic ejection murmur along left sternal borderTruncus arteriosusRareOnset of CHF in first few weeks of life; minimal cyanosisIncreased cardiac impulses; holosystolic murmur (ventricular septal defect); mid-diastolic rumbleCHF = congestive heart failure; LLSB = lower left sternal border; ULSB = upper left sternal border.Information from references 20 through 23.Table 5.Prevalence and Characteristics of Pathologic Heart Murmurs. Type of structural heart lesionPrevalence among children with congenital heart disease (%)Symptoms and clinical courseCharacteristicsVentricular septal defect20 to 25Small defects: usually asymptomaticSmall defects: loud holosystolic murmur at LLSB (may not last throughout systole if defect is very small)Medium or large defects: CHF, symptoms of bronchial obstruction, frequent respiratory infectionsMedium and large defects: increased right-to-left ventricular impulses; thrill at LLSB; split or loud single S2; holosystolic murmur at LLSB without radiation; grade 2 to 5; may also hear a grade 1 or 2 mid-diastolic rumbleAtrial septal defect8 to 13Usually asymptomatic and incidentally found on physical examination or echocardiography; large defects can be present in infants with CHFGrade 2 or 3 systolic ejection murmur best heard at ULSB; wide split fixed S2; absent thrill; may have a grade 1 or 2 diastolic flow rumble at LLSBPatent ductus arteriosus6 to 11May be asymptomatic; can cause easy fatigue, CHF, and respiratory symptomsContinuous murmur (grade 1 to 5) in ULSB (crescendo in systole and decrescendo into diastole); normal S1; S2 may be “buried” in the murmur; thrill or hyperdynamic left ventricular impulse may be presentTetralogy of Fallot10Onset depends on severity of pulmonary stenosis; cyanosis may appear in infancy (2 to 6 months of age) or in childhood; other symptoms include hypercyanotic spells or decreased exercise toleranceCentral cyanosis; clubbing of nail beds; grade 3 or 4 long systolic ejection murmur heard at ULSB; may have holosystolic murmur at LLSB; systolic thrill at ULSB; normal to slightly increased S1; single S2Pulmonary stenosis7.5 to 9Usually asymptomatic but may have symptoms secondary to pulmonary congestionSystolic ejection murmur (grade 2 to 5); heard best at ULSB radiating to infraclavicular regions, axillae, and back; normal or loud S1; variable S2; systolic ejection click may be heard at left sternal border and may vary with respirationCoarctation of the aorta5.1 to 8.1Newborns and infants may present with CHF; older children are usually asymptomatic or may have leg pain or weaknessSystolic ejection murmur best heard over interscapular region; normal S1 and S2; decreased or delayed femoral pulse; may have increased left ventricular impulseAortic stenosis5 to 6Usually asymptomatic; symptoms may include dyspnea, easy fatigue, chest pain, or syncope; newborns and infants may present with CHFSystolic ejection murmur (grade 2 to 5) best heard at upper right sternal border with radiation to carotid arteries; left ventricular heave; thrill at ULSB or suprasternal notchTransposition of the great arteries5Variable presentation depending on type; may include cyanosis or CHF in first week of lifeCyanosis; clubbing of nail beds; single S2; murmur may be absent or grade 1 or 2 nonspecific systolic ejection murmur; may have a grade 3 or 4 holosystolic murmur at LLSB and mid-diastolic murmur at apexTotal anomalous pulmonary venous connection2 to 3Onset of CHF at 4 to 6 weeks of ageGrade 2 or 3 systolic ejection murmur at ULSB; grade 1 or 2 mid-diastolic flow rumble at LLSB; wide split fixed S2Tricuspid atresia1.4Early-onset cyanosis or CHF within the first month of lifeCyanosis; clubbing of nail beds; normal pulses; single S2; holosystolic murmur at LLSB or midsternal border; murmur may be absent; mid-diastolic flow murmur at apex may be presentHypoplastic left heart syndromeRareMay be asymptomatic at birth, with cyanosis and CHF developing with duct closureHyperdynamic precordium; single S2; nonspecific grade 1 or 2 systolic ejection murmur along left sternal borderTruncus arteriosusRareOnset of CHF in first few weeks of life; minimal cyanosisIncreased cardiac impulses; holosystolic murmur (ventricular septal defect); mid-diastolic rumbleCHF = congestive heart failure; LLSB = lower left sternal border; ULSB = upper left sternal border.Information from references 20 through 23.Characteristics that are more likely to be associated with an innocent murmur include a systolic (rather than diastolic) murmur; soft sound; short duration; musical or low pitch; varying intensity with phases of respiration and posture (louder in supine position); and murmurs that become louder with exercise, anxiety, or fear 17,24  (Table 6 27). The most common innocent murmur is a Still murmur, which is characteristically loudest at the lower left sternal border and has a musical or vibratory quality that is thought to represent vibrations of the left outflow tract.1,5  Enlarge      Print Table 6.The Seven S's: Key Features of Innocent Murmurs. Sensitive (changes with child's position or with respiration)Short duration (not holosystolic)Single (no associated clicks or gallops)Small (murmur limited to a small area and nonradiating)Soft (low amplitude)Sweet (not harsh sounding)Systolic (occurs during and is limited to systole)Information from reference 27.Table 6.The Seven S's: Key Features of Innocent Murmurs. Sensitive (changes with child's position or with respiration)Short duration (not holosystolic)Single (no associated clicks or gallops)Small (murmur limited to a small area and nonradiating)Soft (low amplitude)Sweet (not harsh sounding)Systolic (occurs during and is limited to systole)Information from reference 27.Auscultation may be less accurate in younger patients, when other signs or symptoms of cardiovascular disease are present, and when findings on radiography or electrocardiography (ECG) are abnormal.28  Online libraries of digital heart sounds are available to familiarize physicians with the characteristics of abnormal heart sounds (Table 7).  Enlarge      Print Table 7.Online Resources for Pediatric Cardiac Auscultation. The Auscultation AssistantWeb site: http://www.wilkes.med.ucla.edu/inex.htmBlaufuss Medical Multimedia LaboratoriesWeb site: http://www.blaufuss.orgHeart Sounds and MurmursWeb site: http://www.dundee.ac.uk/medther/Cardiology/hsmur.htmlJohns Hopkins University Cardiac Auscultatory Recording DatabaseWeb site: http://www.murmurlab.com/card6/ (registrationrequired)Texas Heart InstituteWeb site: http://www.texasheart.org/education/cme/explore/events/eventdetail_5469.cfmUniversity of Michigan Heart Sound and Murmur LibraryWeb site: http://www.med.umich.edu/lrc/psb/heartsounds/index.htmUniversity of Washington Department of MedicineDemonstrations: Heart Sounds and MurmursWeb site: http://depts.washington.edu/physdx/heart/demo.htmlTable 7.Online Resources for Pediatric Cardiac Auscultation. The Auscultation AssistantWeb site: http://www.wilkes.med.ucla.edu/inex.htmBlaufuss Medical Multimedia LaboratoriesWeb site: http://www.blaufuss.orgHeart Sounds and MurmursWeb site: http://www.dundee.ac.uk/medther/Cardiology/hsmur.htmlJohns Hopkins University Cardiac Auscultatory Recording DatabaseWeb site: http://www.murmurlab.com/card6/ (registrationrequired)Texas Heart InstituteWeb site: http://www.texasheart.org/education/cme/explore/events/eventdetail_5469.cfmUniversity of Michigan Heart Sound and Murmur LibraryWeb site: http://www.med.umich.edu/lrc/psb/heartsounds/index.htmUniversity of Washington Department of MedicineDemonstrations: Heart Sounds and MurmursWeb site: http://depts.washington.edu/physdx/heart/demo.htmlRole of Diagnostic Testing. Jump to section + Abstract Incidence and PrevalenceHistoryPhysical ExaminationRole of Diagnostic TestingIndications for ReferralNeonatal Heart MurmursReferencesChest radiography and ECG rarely assist in the diagnosis of a heart murmur.5,6,29 Studies in newborns30 and children31 with asymptomatic murmurs have shown that chest radiography does not influence clinical management or assist with diagnosis. A prospective study of 201 newborns who were referred to pediatric cardiologists for evaluation of a heart murmur found that the addition of ECG to clinical assessment did not improve the sensitivity or specificity of detecting structural heart lesions.32 In a study of 128 infants and children who were evaluated for heart murmurs, the addition of ECG and chest radiography to cardiac auscultation was more likely to mislead than assist the physician in making the correct diagnosis.33In a study of more than 900 children in a pediatric cardiology clinic who had innocent-sounding murmurs, an abnormal finding from the history, physical examination, or diagnostic tests (ECG, chest radiography, or pulse oximetry) was 67 percent sensitive but only 38 percent specific for the presence of a structural heart lesion in infants younger than six weeks, yielding positive and negative LRs very near 1.0 (i.e., no useful diagnostic information).28 In infants older than six weeks, sensitivity increased to 100 percent, but specificity decreased to 28 percent (positive LR = 1.6; negative LR = 0.026). Thus, this information is helpful for ruling out structural causes of an innocent-sounding murmur in infants and children older than six weeks, but it is not helpful in younger infants.In two separate populations geographically remote from a pediatric cardiologist, phonocardiography (i.e., digital heart sound recordings reviewed by a pediatric cardiologist) had high sensitivity and specificity, and good intraobserver agreement in distinguishing between innocent murmurs and murmurs that were potentially or probably pathologic and that required echocardiography.34,35Indications for Referral. Jump to section + Abstract Incidence and PrevalenceHistoryPhysical ExaminationRole of Diagnostic TestingIndications for ReferralNeonatal Heart MurmursReferencesIn children and adolescents, the diagnosis of an innocent heart murmur can be made if four criteria are met: absence of abnormal physical examination findings (except for the murmur); a negative review of systems (i.e., child is asymptomatic); a history that is negative for features that increase the risk of structural heart disease; and characteristic auscultatory features of a specific innocent heart murmur.2,5 These criteria are not appropriate for newborns or infants younger than one year because these patients have a higher rate of asymptomatic structural heart disease.36 When an innocent murmur cannot be definitively diagnosed, the child should be referred for echocardiography, to a pediatric cardiologist, or both.A study in Oman found that the prevalence of abnormal findings on echocardiography was not significantly different between patients referred by pediatric cardiologists and those referred by primary care physicians.37 However, pediatric cardiologists more accurately detect structural heart lesions in newborns and children with heart murmurs,32,38 and can assist family physicians in the assessment of a suspicious murmur. For both innocent and pathologic murmurs, referral to a pediatric cardiologist for confirmation or clarification of the diagnosis is associated with decreased parental anxiety.39Neonatal Heart Murmurs. Jump to section + Abstract Incidence and PrevalenceHistoryPhysical ExaminationRole of Diagnostic TestingIndications for ReferralNeonatal Heart MurmursReferencesNewborns are at higher risk of having serious structural heart disease that presents as an asymptomatic murmur.6,10 Approximately 1 percent of newborns have a heart murmur, and 31 to 86 percent of these infants have structural heart disease,40–42 including asymptomatic newborns. Because of the higher likelihood of structural heart disease in asymptomatic newborns and young infants with heart murmurs, referral to a pediatric cardiologist and/or for echocardiography is recommended.28,42,43 Even potentially life-threatening heart defects may not be associated with any initial signs or symptoms other than a heart murmur.41,42The reported sensitivity for detection of a pathologic heart murmur in newborns ranges from 80.5 to 94.9 percent among pediatric cardiologists, with specificity ranging from 25 to 92 percent.32,43 These variations are significant because the lowest specificity corresponds to positive and negative LRs of 1.1 and 0.7, which are uninformative, and the highest specificity corresponds to positive and negative LRs of 10 and 0.21, which are quite accurate. The ability of a pediatric cardiologist to accurately identify pathologic murmurs depends on multiple factors, including his or her confidence in the diagnosis. Echocardiography may not be required in newborns with a heart murmur if a pediatric cardiologist has diagnosed an innocent murmur with a high degree of confidence32; however, it is important to consider the relatively high prevalence of structural heart disease among asymptomatic newborns with a heart murmur.The evaluation of newborns for CHD may include pulse oximetry after 24 hours of life. Clinical examination of asymptomatic newborns has a sensitivity of 46 percent for detection of CHD; this sensitivity increases to 77 percent when clinical examination is combined with pulse oximetry (with a cutoff of 94 percent).44Read the full article.Get immediate access, anytime, anywhere.Choose a single article, issue, or full-access subscription.Earn up to 6 CME credits per issue.Already a member/subscriber? Log in >> Purchase Access:See My OptionscloseAlready a member or subscriber? Log in . Best Value!Get Full AccessFrom $145SubscribeIncludes:Immediate, unlimited access to all AFP contentMore than 130 CME credits per yearAccess the journal through the AAFP appPrint delivery option . Access This Issue$59.95 Includes:Immediate access to this issue  CME credits in this issue . Access This Article$25.95  Includes:Immediate access to this articleInterested in AAFP membership? Learn more     To see the full article, log in or purchase access.The Authors. show all author infoJENNIFER E. FRANK, MD, FAAFP, is in private practice at Theda Care Physicians in Neenah, Wis. At the time this article was written, she was an assistant professor of family medicine at the University of Wisconsin School of Medicine and Public Health, Madison, and a faculty member at the University of Wisconsin Fox Valley Family Medicine Residency Program, Appleton....KATHRYN M. JACOBE, MD, is a third-year resident at the University of Wisconsin Fox Valley Family Medicine Residency Program.Address correspondence to Jennifer E. Frank, MD, FAAFP, 1380 Tullar Rd., Neenah, WI 54956 (e-mail: [email protected]). Reprints are not available from the authors.Author disclosure: No relevant financial affiliations to disclose.REFERENCES. show all references1. Biancaniello T. Innocent murmurs. Circulation. 2005;111(3):e20–e22....2. Harris JP. Consultation with the specialist. Evaluation of heart murmurs. Pediatr Rev. 1994;15(12):490–494.3. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890–1900.4. Pelech AN. Evaluation of the pediatric patient with a cardiac murmur. Pediatr Clin North Am. 1999;46(2):167–188.5. Danford DA. Effective use of the consultant, laboratory testing, and echocardiography for the pediatric patient with heart murmur. Pediatr Ann. 2000;29(8):482–488.6. Poddar B, Basu S. Approach to a child with a heart murmur. Indian J Pediatr. 2004;71(1):63–66.7. Martins P, Dinis A, Canha J, Ramalheiro G, Castela E. Innocent heart murmurs. Rev Port Cardiol. 2008;27(6):815–831.8. Weber MA, Ashworth MT, Risdon RA, Brooke I, Malone M, Sebire NJ. Sudden unexpected neonatal death in the first week of life: autopsy findings from a specialist centre. J Matern Fetal Neonatal Med. 2009;22(5):398–404.9. Gordon JB, Kahn AM, Burns JC. When children with Kawasaki disease grow up: myocardial and vascular complications in adulthood. J Am Coll Cardiol. 2009;54(21):1911–1920.10. Frommelt MA. Differential diagnosis and approach to a heart murmur in term infants. Pediatr Clin North Am. 2004;51(4):1023–1032.11. Merlob P, Birk E, Sirota L, et al. Are selective serotonin reuptake inhibitors cardiac teratogens? Echocardiographic screening of newborns with persistent heart murmur. Birth Defects Res A Clin Mol Teratol. 2009;85(10):837–841.12. Macicek SM, Macias CG, Jefferies JL, Kim JJ, Price JF. Acute heart failure syndromes in the pediatric emergency department. Pediatrics. 2009;124(5):e898–e904.13. Kane DA, Fulton DR, Saleeb S, Zhou J, Lock JE, Geggel RL. Needles in hay: chest pain as the presenting symptom in children with serious underlying cardiac pathology. Congenit Heart Dis. 2010;5(4):366–373.14. Geggel RL. Conditions leading to pediatric cardiology consultation in a tertiary academic hospital. Pediatrics. 2004;114(4):e409–e417.15. Andren L, Hall P. Diminished segmentation or premature ossification of the sternum in congenital heart disease. Br Heart J. 1961;23:140–142.16. Washington R. Sports cardiology in the adolescent athlete: concerns for the pediatrician. Pediatr Ann. 2007;36(11):698–702.17. Pelech AN. The physiology of cardiac auscultation. Pediatr Clin North Am. 2004;51(6):1515–1535.18. McConnell ME, Adkins SB III, Hannon DW. Heart murmurs in pediatric patients: when do you refer? Am Fam Physician. 1999;60(2):558–565.19. Christensen DD, Vincent RN, Campbell RM. Presentation of atrial septal defect in the pediatric population. Pediatr Cardiol. 2005;26(6):812–814.20. Syamasundar Rao P. Diagnosis and management of acyanotic heart disease: part I — obstructive lesions. Indian J Pediatr. 2005;72(6):496–502.21. Syamasundar Rao P. Diagnosis and management of acyanotic heart disease: part II — left-to-right shunt lesions. Indian J Pediatr. 2005;72(6):503–512.22. Rao PS. Diagnosis and management of cyanotic congenital heart disease: part I. Indian J Pediatr. 2009;76(1):57–70.23. Syamasundar Rao P. Diagnosis and management of cyanotic congenital heart disease: part II. Indian J Pediatr. 2009;76(3):297–308.24. Uner A, Doğan M, Bay A, Cakin C, Kaya A, Sal E. The ratio of congenital heart disease and innocent murmur in children in Van city, the Eastern Turkey. Anadolu Kardiyol Derg. 2009;9(1):29–34.25. McCrindle BW, Shaffer KM, Kan JS, Zahka KG, Rowe SA, Kidd L. Cardinal clinical signs in the differentiation of heart murmurs in children. Arch Pediatr Adolesc Med. 1996;150(2):169–174.26. Etchells E, Bell C, Robb K. Does this patient have an abnormal systolic murmur? JAMA. 1997;277(7):564–571.27. Bronzetti G, Corzani A. The seven “S” murmurs: an alliteration about innocent murmurs in cardiac auscultation. Clin Pediatr (Phila). 2010;49(7):713.28. Danford DA, Martin AB, Fletcher SE, Gumbiner CH. Echocardiographic yield in children when innocent murmur seems likely but doubts linger. Pediatr Cardiol. 2002;23(4):410–414.29. Yi MS, Kimball TR, Tsevat J, Mrus JM, Kotagal UR. Evaluation of heart murmurs in children: cost-effectiveness and practical implications. J Pediatr. 2002;141(4):504–511.30. Oeppen RS, Fairhurst JJ, Argent JD. Diagnostic value of the chest radiograph in asymptomatic neonates with a cardiac murmur. Clin Radiol. 2002;57(8):736–740.31. Birkebaek NH, Hansen LK, Elle B, et al. Chest roentgenogram in the evaluation of heart defects in asymptomatic infants and children with a cardiac murmur: reproducibility and accuracy. Pediatrics. 1999;103(2):E15.32. Mackie AS, Jutras LC, Dancea AB, Rohlicek CV, Platt R, Béland MJ. Can cardiologists distinguish innocent from pathologic murmurs in neonates? J Pediatr. 2009;154(1):50–54.33. Rajakumar K, Weisse M, Rosas A, et al. Comparative study of clinical evaluation of heart murmurs by general pediatricians and pediatric cardiologists. Clin Pediatr (Phila). 1999;38(9):511–518.34. Mahnke CB, Mulreany MP, Inafuku J, Abbas M, Feingold B, Paolillo JA. Utility of store-and-forward pediatric telecardiology evaluation in distinguishing normal from pathologic pediatric heart sounds. Clin Pediatr (Phila). 2008;47(9):919–925.35. Germanakis I, Dittrich S, Perakaki R, Kalmanti M. Digital phonocardiography as a screening tool for heart disease in childhood. Acta Paediatr. 2008;97(4):470–473.36. Koo S, Yung TC, Lun KS, Chau AK, Cheung YF. Cardiovascular symptoms and signs in evaluating cardiac murmurs in children. Pediatr Int. 2008;50(2):145–149.37. Venugopalan P, Agarwal AK, Johnston WJ, Riveria E. Spread of heart diseases seen in an open-access paediatric echocardiography clinic. Int J Cardiol. 2002;84(2–3):211–216.38. Advani N, Menahem S, Wilkinson JL. The diagnosis of innocent murmurs in childhood. Cardiol Young. 2000;10(4):340–342.39. Giuffre RM, Walker I, Vaillancourt S, Gupta S. Opening Pandora's box: parental anxiety and the assessment of childhood murmurs. Can J Cardiol. 2002;18(4):406–414.40. Bansal M, Jain H. Cardiac murmur in neonates. Indian Pediatr. 2005;42(4):397–398.41. Rein AJ, Omokhodion SI, Nir A. Significance of a cardiac murmur as the sole clinical sign in the newborn. Clin Pediatr (Phila). 2000;39(9):511–520.42. Ainsworth S, Wyllie JP, Wren C. Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child Fetal Neonatal Ed. 1999;80(1):F43–F45.43. Azhar AS, Habib HS. Accuracy of the initial evaluation of heart murmurs in neonates: do we need an echocardiogram? Pediatr Cardiol. 2006;27(2):234–237.44. Bakr AF, Habib HS. Combining pulse oximetry and clinical examination in screening for congenital heart disease. Pediatr Cardiol. 2005;26(6):832–835.Add/view commentsHide comments    Copyright © 2011 by the American Academy of Family Physicians. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact [email protected] for copyright questions and/or permission requests. PDF PRINT COMMENTS Want to use this article elsewhere? Get Permissions Advertisement More in AFP Related Content. Valvular Heart Disease More in Pubmed Citation Related Articles MOST RECENT ISSUE Jan 2022 Access the latest issue of American Family Physician Read the Issue Email Alerts. Don't miss a single issue. Sign up for the free AFP email table of contents. Sign Up Now Navigate this Article Continue reading from October 1, 2011. Previous: Interacting with Patients' Family Members During the Office Visit Next: Treatment of Adult Obesity with Bariatric Surgery View the full table of contents >> Home / Journals / afp / Vol. 84/No. 7(October 1, 2011) / Evaluation and Management of Heart Murmurs in Children
Topics
  • Topic
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  • murmur
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  • heart
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  • systolic
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  • pediatric cardiologist
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  • ejection murmur heard
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  • holosystolic murmur llsb
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  • oriented evidence
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  • patent ductu
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  • abstract incidence prevalencehistoryphysical
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Result 9
TitleHeart Murmurs in Children - Health Encyclopedia - University of Rochester Medical Center
Urlhttps://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P01806
Description
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Organic Position9
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Body/www.googletagmanager.com/ns.htmlid=GTM-W2QNSJ" height="0" width="0" style="display:none;visibility:hidden" title="GTM">
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TitleMy child has a heart murmur, what does it mean? | Edward-Elmhurst Health
Urlhttps://www.eehealth.org/blog/2018/11/children-heart-murmurs/
DescriptionDid your child’s doctor discover a heart murmur during his/her routine check-up? Before you panic, know that most children with heart murmurs don’t have an actual heart problem
DateNov 29, 2018
Organic Position10
H1
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H2WithAnchors
Body"https://www.googletagmanager.com/ns.html?id=GTM-W4LTMM" height="0" width="0" style="display:none;visibility:hidden"> If you have reached this screen, your current device or browser is unable to access the full Edward-Elmhurst Health Web site. To see the full site, please upgrade your browser to the most recent version of Safari, Chrome, Firefox or Internet Explorer. If you cannot upgrade your browser, you can remain on this site.
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TitleHeart Murmurs in Children | Children's Healthcare of Atlanta
Urlhttps://www.choa.org/parent-resources/heart/heart-murmurs-in-children
DescriptionHeart murmurs may or may not be serious. Our team of pediatric cardiologists is here to explain what heart murmurs mean
Date
Organic Position11
H1
H2Heart Murmurs in Children
A hospital reimagined
What does a heart murmur mean?
We're Here to Help with Matters of the Heart
H3What is a heart murmur?
What is an innocent heart murmur?
What is a serious heart murmur, and what does it mean for my child?
Does a heart murmur mean my child has a heart problem?
Do heart murmurs require further testing?
My child's pediatrician heard a heart murmur. Now what?
Children’s License Agreement
H2WithAnchorsHeart Murmurs in Children
A hospital reimagined
What does a heart murmur mean?
We're Here to Help with Matters of the Heart
BodyCOVID-19 Updates We are experiencing high volumes, which has led to increased wait times at our emergency departments and urgent care locations. CHECK WAIT TIMES > CHANGES TO OUR VISITOR POLICY (11/19/21)> COVID-19 RESOURCES > COVID-19 VACCINES> COVID-19 Updates Heart Murmurs in Children . . Heart murmurs in children are one of the four most common reasons for new-patient referrals to the Children's Healthcare of Atlanta Heart Center. Our doctors have found that there is a lot of misinformation about what a heart murmur is and what it means for a child who has one. Here, Robert Campbell, MD, Pediatric Cardiologist, explains heart murmurs in children and what they may mean for patients and families. What is a heart murmur? In the simplest terms, a heart murmur is the noise of turbulent blood flow. “Think about a mountain stream,” Dr. Campbell says. “Smooth water flow in the stream makes close to no noise, but the same water downstream over the rocks and rapids makes a lot of noise. That's because it's a turbulent area for water.” Pediatricians can hear these murmurs through the stethoscope while listening to your child's heartbeat. What is an innocent heart murmur? Even normal blood flow has turbulence. When this occurs, it’s referred to as an innocent murmur. “Innocent murmurs are simply the noises made as blood flows through the heart, over the valves and through the blood vessels. These heart murmurs in children are common, and they will often disappear on their own as children get older,” says Dr. Campbell. If your child is diagnosed with an innocent heart murmur, no further testing is needed. These murmurs may come and go over time and can vary in loudness depending on a patient’s position during an exam. Symptoms are not expected, and activity restrictions are not required. Generally, after a pediatric cardiology evaluation and clearance, patients with innocent murmurs will be followed long term by their pediatric care providers. What is a serious heart murmur, and what does it mean for my child? If a pediatric cardiologist confirms through testing that your child’s heart murmur is serious, then it could be caused by a heart condition. “Not all heart murmurs are the same,” explains Dr. Campbell. “Some heart murmurs may be the first sign of underlying heart disease. Others could be caused by more minor heart conditions. Still other heart murmurs may be caused by a heart defect.” The Future of Pediatric Care A hospital reimagined. When it comes to caring for kids, we’ve never settled for just good enough. We need your help—now more than ever—to give our patients the futures they deserve. JOIN US What does a heart murmur mean? . . Does a heart murmur mean my child has a heart problem? A heart murmur and heart disease are not the same thing. A heart murmur is the noise of turbulent blood flow, and all blood flow is turbulent inside normal and abnormal hearts. In some thin-chested patients, the noise of normal turbulent blood flow may be heard; these are called innocent heart murmurs, and there are several different types. On the other hand, some heart murmurs may be the first sign of underlying heart disease, such as a hole in the heart, blocked valve, leaky valve, heart muscle problem or blood vessel problem. Do heart murmurs require further testing? If your child's pediatrician hears a heart murmur, he or she should be able to detect the difference between an innocent and serious heart murmur. “If any heart murmur is detected, your pediatrician should get a full medical history of your child and may want to run tests to be sure the heart murmur is, in fact, innocent,” says Dr. Campbell. “Once tests confirm the heart murmur is innocent, there's usually no need for a follow-up appointment.” Evaluation of a heart murmur may include a: Detailed family history Patient history Physical exam Resting electrocardiogram (ECG) Chest X-ray or an echocardiography (heart ultrasound) If there is any concern that your child's heart murmur is serious, your pediatrician will refer you to a pediatric cardiologist. My child's pediatrician heard a heart murmur. Now what? If your child has a heart condition that requires further pediatric testing, it's critical that your child see a pediatric cardiologist, who has special training and equipment to care for small and growing hearts. We're Here to Help with Matters of the Heart. Can Children and Teens With Heart Defects Play Sports? Chest Pain in Children. Signs of Heart Problems in Children and Teens. Contact Us 404-785-KIDS (5437) × Modal title.   Children’s License Agreement. Children’s Healthcare of Atlanta (“CHOA”) provides free access to certain materials and information, documentation, forms, questionnaires and diagrams relating to the study, prevention, and treatment of concussions via this website and its related pages, including without limitation, for your reference or download (collectively, the “Concussion Program Materials”) as described in this License agreement (“Agreement”). By accessing the Concussion Program Materials, you accept and agree to the terms and conditions of this Agreement. 1. Right to Access and Use. CHOA hereby provides you a fully-paid, nontransferable, nonexclusive, personal right and license to access, download, or otherwise use any Concussion Program Materials solely for the following purposes: (i) if you are accessing the materials as a parent, you may use the Concussion Program Materials for your personal, non-commercial use to educate yourself and your family on concussion prevention and treatment for a child; (ii) if you are accessing the materials as an athletics coach or on behalf of a school organization, you may use the Concussion Program Materials to promote concussion safety to your staff, students and athletes and to create appropriate concussion management procedures; and (iii) if you are a healthcare provider, you may use the Concussion Program Materials for your personal, professional development to enhance your medical knowledge in the field of concussions. You acknowledge the Concussion Program Materials are not to be used as definitive diagnostic tools with any specific patient and your independent medical judgment will be used to treat any patient. You must maintain all CHOA proprietary notices on the Concussion Program Materials. You may not copy, modify, adapt, reverse engineer or create derivative works of the Concussion Program Materials or remove any copyright or other proprietary rights notices therefrom. Notwithstanding the foregoing, where indicated in the Concussion Program Materials, schools and sports organizations are permitted to co-brand certain of the Concussion Program Materials with CHOA’s prior written consent. Additionally, schools, sports programs and recreational leagues may put their own logo on the Concussion Policy and modify it to meet their needs. 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TitleHeart Murmur | Boston Children's Hospital
Urlhttps://www.childrenshospital.org/conditions-and-treatments/conditions/h/heart-murmur
DescriptionA heart murmur is a sound heard during a heartbeat. Learn more from Boston Children’s Hospital
Date
Organic Position12
H1Heart Murmur
H2What is a heart murmur?
What causes heart murmurs?
How are heart murmurs diagnosed?
What is the treatment for a heart murmur?
How we care for heart murmurs
H3Related Conditions and Treatments
Kevin B. Churchwell, President and CEO
About Boston Children's
I want to:
Public Relations
H2WithAnchorsWhat is a heart murmur?
What causes heart murmurs?
How are heart murmurs diagnosed?
What is the treatment for a heart murmur?
How we care for heart murmurs
BodyHeart Murmur What is a heart murmur? A heart murmur is a sound made by blood moving through the heart's chambers or valves. Murmurs range from quite faint to very loud. There are two main types of heart murmurs: innocent (harmless) and abnormal. Most cases of heart murmurs in children are innocent heart murmurs that are not caused by a heart problem. Most abnormal murmurs in children are due to a congenital heart defect or a vascular anomaly. What causes heart murmurs? Heart murmurs may be caused by a number of conditions related to turbulent flow or acceleration of blood in the heart, including: heart valve problems holes in the heart walls narrowing of vessels peripheral pulmonary stenosis fever anemia How are heart murmurs diagnosed? You child’s doctor will evaluate your child’s murmur based on its pitch, character, location, loudness, and duration. Your pediatrician will decide if your child needs to be seen by a cardiologist. The most important thing early on is to diagnose the cause of the murmur. Murmurs related to a congenital heart defect or other problem involving the heart will be heard the loudest in the area of the chest where the problem occurs.' What is the treatment for a heart murmur? Most heart murmurs in children are benign and don’t need treatment or follow up. If your child has an abnormal heart murmur that’s caused by another heart condition, he or she may need treatment for that condition. How we care for heart murmurs. If your child has a heart murmur caused by a heart condition, the Boston Children’s Hospital Benderson Family Heart Center has one of the world’s largest teams of highly trained pediatric cardiologists and pediatric cardiac surgeons, including special expertise across dozens of programs and services. Our team treats a full spectrum of cardiac disorders, including the rarest and most complex congenital heart defects. Related Conditions and Treatments. Congenital Heart Defects Aplastic Anemia Fever The commitment and compassion with which we care for all children and families is matched only by the pioneering spirit of discovery and innovation that drives us to think differently, to find answers, and to build a better tomorrow for children everywhere. Kevin B. Churchwell, President and CEO. Connect with Boston Children's Hospital Boston Children's Hospital #1 Ranked Children's Hospital by U. S. News & World Report 300 Longwood Avenue, Boston, MA 02115  617-355-6000 Donate About Boston Children's. About Us Virtual Visits MyChildren's Patient Portal Quality & Patient Safety Giving Career Opportunities Locations Education & Training I want to:. Find A Doctor Get A Second Opinion Learn About Conditions Make A Referral Request An Appointment Volunteer Make a Suggestion Contact Us Public Relations. Newsroom Patient & Family Rights Government Relations HIPAA Notice of Privacy Practices Terms of Use © 2005-2022 All Rights Reserved
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Result 13
TitleHeart Murmurs in Children. What is a heart murmur? | Patient
Urlhttps://patient.info/doctor/heart-murmurs-in-children
DescriptionSee also the separate Heart Auscultation article. Heart murmurs are common in asymptomatic and otherwise well children. Many murmurs are innocent and result ..
DateDec 13, 2020
Organic Position13
H1Heart Murmurs in Children
H2Presentation
Characteristics of the murmur
Pathological murmurs
Innocent murmurs[4]
Neonatal heart murmurs
Investigations
Management
Patient and family education
H3Does this child have heart disease?[3]
Symptoms of heart disease
Signs of heart disease
Predisposing medical conditions
Innocent Murmurs
Evaluation of murmurs[7]
Feeling unwell?
H2WithAnchorsPresentation
Characteristics of the murmur
Pathological murmurs
Innocent murmurs[4]
Neonatal heart murmurs
Investigations
Management
Patient and family education
BodyHeart Murmurs in Children Authored by Dr Colin Tidy, Reviewed by Dr Laurence Knott | Last edited 13 Dec 2020 | Meets Patient’s editorial guidelines This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find the Heart Disease article more useful, or one of our other health articles. Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.Heart Murmurs in Children. In this article Presentation Characteristics of the murmur Pathological murmurs Innocent murmurs Neonatal heart murmurs Investigations Management Patient and family education See also the separate Heart Auscultation article.Heart murmurs are common in asymptomatic and otherwise well children. Many murmurs are innocent and result from normal patterns of blood flow through heart and blood vessels[1].However, a murmur can be the sole manifestation of structural heart disease. More than 50% of newborns with congenital heart disease are unrecognised at birth[2]. Therefore, a careful evaluation is essential. If in doubt, referral to a paediatrician with expertise in cardiology (PEC) or a paediatric cardiologist is necessary.Presentation. Does this child have heart disease?[3]. The key question which is raised on the detection of a heart murmur is: 'Does this child have a heart disease?' To answer this, three groups of factors need to be considered:Are there any symptoms and signs of heart disease?Are there any predisposing medical conditions?What are the characteristics of the murmur?Symptoms of heart disease. The symptoms vary with the age of the child and are more nonspecific in infants. One or more of the following may be present:InfantOlder ChildBreathlessnessExercise intolerancePoor feedingPalpitationsExcessive sweatingChest painBlue episodesSyncopeGenerally unwellPedal oedemaNot gaining weightPositive family historyPositive family history Signs of heart disease. InfantOlder ChildTachypnoeaTachypnoeaTachycardiaTachycardiaHepatomegalyHepatomegalyPoor peripheral pulsesPoor peripheral pulsesLow oxygen saturationsElevated jugular venous pressure (JVP)Faltering growth (growth chart)Pedal oedema Basal lung crepitationsPredisposing medical conditions. Down's syndromeNoonan's syndromeTurner syndromeMarfan's syndromeFetal alcohol syndromeFetal rubella infectionCharacteristics of the murmur. Each heart murmur must be analysed in terms of intensity (grades 1 to 6), timing (systolic or diastolic), location, transmission and quality (musical, vibratory, blowing, harsh, etc).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 borderPulmonary stenosis (PS), atrial septal defect (ASD), innocent pulmonary flow murmur, tetralogy of Fallot (TOF), coarctation of the aorta (CoA), aortic stenosis (AS), patent ductus arteriosus (PDA) with pulmonary hypertensionUpper right sternal borderAS, supravalvular AS, subaortic stenosisLower left sternal borderVentricular septal defect (VSD), Still's murmur, hypertrophic obstructive cardiomyopathy (HOCM), tricuspid regurgitation (TR)Apical areaMitral regurgitation (MR), mitral valve prolapse (MVP), HOCM, vibratory innocent murmurLikewise timing of the murmur can help in identifying the cause of the murmur:SystolicDiastolicContinuousVSDAortic regurgitation (AR)PDATRPulmonary regurgitation (PR)Venous humMRMitral stenosis (MS)Arteriovenous malformations (AVMs)PS  AS  ASD  PDA  Pathological murmurs. Diastolic murmurs are pathological. Six cardinal signs are described which indicate that a systolic murmur is likely to be pathological, ie because of an underlying heart defect. These are:Holosystolic (pansystolic) murmur.Harsh murmur.Abnormal heart sounds.Early or mid-systolic click.Grade 3 murmur or greater.Heard over upper left sternal border.Innocent murmurs[4]. Sensitive (changes with child's position or with respiration).Short duration (not holosystolic).Single (no associated clicks or gallops).Small (murmur limited to a small area and not radiating).Soft (low amplitude).Sweet (not harsh-sounding).Systolic (occurs and is limited to systole).Five types of innocent murmurs in childhood are described, all with diagnostic clinical features. However, the differential diagnosis always includes pathological murmurs because of various heart defects. These are summarised below:Innocent Murmurs. NameFeaturesDifferentialStill's murmurMid-left sternal border, mid-systolic, grades 2-3, twanging string, musical, vibratory soundVSDPulmonary flow murmurUpper left sternal border, mid-systolic, grades 1-3, gratingPS, ASDVenous humRight and/or left infraclavicular, continuous, only heard in upright position, diastolic component louder than systolicPDACarotid bruit (supraclavicular systolic murmur)Supraclavicular area, ejection systolic, grades 2-3ASPeripheral pulmonary stenosis (pulmonary flow murmur of newborn)Upper left sternal border, grades 1-2, radiates to axillae and back, usually disappears by 6 months of agePSNeonatal heart murmurs. Heart murmurs in neonates are much more likely to indicate structural heart disease and should prompt specialist assessment.One study of 6,333 healthy newborn babies found heart murmurs in 87 (1.37%) neonates, of whom 42.5% had a structural cardiac malformation. Ventricular septal defect (62%) was the most common diagnosis, followed by atrial septal defect, pulmonary stenosis and patent ductus arteriosus[5].Even potentially life-threatening heart defects may have no other signs or symptoms in addition to the heart murmurs. A very thorough evaluation including detailed clinical examination, femoral pulse check along with pulse oximetry (pre- and post-ductal saturations) is mandatory. Those with clinical signs, difficult-to-palpate femoral pulses or low oxygen saturations require prompt echocardiographic assessment. Neonates with heart murmurs who are clinically asymptomatic should also be referred for a routine echocardiographic assessment.Investigations. ECG and CXR have limited use in the diagnosis of underlying pathology associated with pathological heart murmurs, with low sensitivity and specificity for identifying cardiac defects or anatomical abnormalities.Echocardiography is the gold standard to diagnose congenital cardiac malformations definitively in paediatric patients. It is indicated in any child with an asymptomatic heart murmur which has attributes of a pathological murmur or when the examiner is not comfortable in making a clinical diagnosis of an innocent heart murmur. This can usually be done by a PEC in a district general hospital setting, minimising the need for referral to a tertiary cardiology service[6].Management. Any child found to have a heart murmur should have a thorough clinical evaluation including pulse oximetry and palpation of femoral pulses. Clinically unwell children or those with red flags such as difficult-to-feel femorals or low oxygen saturations need urgent referral for specialist cardiac evaluation. It is important to remember that absence of symptoms does not exclude important pathology. If in doubt, referral to a PEC or a paediatric cardiologist is essential. The American College of Cardiology recommends a low threshold for echocardiographic evaluation of heart murmurs, as shown below[7].Evaluation of murmurs[7]. Systolic murmursMidsystolic:Grade 2 or less:Asymptomatic and no associated signs - no further workup.Symptomatic or other signs of cardiac disease - echocardiogram.Grade 3 or more - echocardiogram.Early systolic, late systolic, holosystolic:Echocardiogram.Diastolic and continuous murmursAll diastolic and continuous murmurs must be evaluated using echocardiography.The National Institute for Health and Care Excellence (NICE) no longer recommends routine antibiotic prophylaxis in children with structural heart disease but emphasises the importance of maintaining good oral health[8].Patient and family education. Once a heart murmur is confirmed to be innocent, reassurance to the family regarding its benign nature is important. Although the murmur may never disappear and may persist into adulthood, the parent and child need to be specifically reassured that an innocent murmur is simply an additional noise audible to the clinician and not a disease or illness, and is therefore completely harmless.Take our quick 5 minute survey to share your thoughts on Patient.info articlesStart surveyFurther reading and references. Doshi AR; Innocent Heart Murmur. Cureus. 2018 Dec 510(12):e3689. doi: 10.7759/cureus.3689.Yoon SA, Hong WH, Cho HJ; Congenital heart disease diagnosed with echocardiogram in newborns with asymptomatic cardiac murmurs: a systematic review. BMC Pediatr. 2020 Jun 3020(1):322. doi: 10.1186/s12887-020-02212-8.Evaluation of suspected congenital heart disease; Paediatrics and Child Health, January 2011Frank JE, Jacobe KM; Evaluation and management of heart murmurs in children. Am Fam Physician. 2011 Oct 184(7):793-800.Lardhi AA; Prevalence and clinical significance of heart murmurs detected in routine neonatal examination. J Saudi Heart Assoc. 2010 Jan22(1):25-7. doi: 10.1016/j.jsha.2010.03.005. Epub 2010 Mar 10.Managed Care Network for the assessment of cardiac problems in children in a district general hospital: a working model; Arch Dis Child. Nov 2006 91(11): 892–895Nishimura RA, Otto CM, Bonow RO, et al; 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Jun 10129(23):2440-92. doi: 10.1161/CIR.0000000000000029. Epub 2014 Mar 3.Prophylaxis against infective endocarditis: Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures; NICE Clinical Guideline (March 2008 - last updated July 2016)Related Information. Heart DiseaseAtrial Septal DefectAtrial Septal DefectNewborn Baby Screening TestsVentricular Septal Defect So iv been having some strange things going on in my body the last month or so and I'm wondering if anyone can give me some incite on what might be going on. The last two weeks have been the worst as... Terry93Join the discussion on the forums Health Tools Feeling unwell?Assess your symptoms online with our free symptom checker. Start symptom checker Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions. close newnav-downnewnav-up
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TitleHeart murmur in children & teenagers | Raising Children Network
Urlhttps://raisingchildren.net.au/guides/a-z-health-reference/heart-murmur
DescriptionA heart murmur is an extra noise in the heart. Heart murmurs can be innocent and nothing to worry about. Abnormal heart murmurs might need treatment
DateJul 9, 2021
Organic Position14
H1
H2About heart murmur in children
Symptoms of heart murmur in children
Does your child need to see a doctor about heart murmur?
Tests for heart murmur
Heart murmur treatment
H3
H2WithAnchorsAbout heart murmur in children
Symptoms of heart murmur in children
Does your child need to see a doctor about heart murmur?
Tests for heart murmur
Heart murmur treatment
BodySkip to content Skip to navigation Toggle Main Nav MenuToggle Header Searchclose About heart murmur in children. Blood flowing through the heart usually makes a lub-dub noise. A heart murmur is when the blood makes an extra noise in the heart – a whoosh, swish or hum. It happens when the blood isn’t flowing smoothly through the heart.Some heart murmurs are innocent heart murmurs. This means there’s nothing wrong with your child’s heart, and the murmur usually goes away with time.Innocent heart murmurs are most common kind of heart murmurs in children and teenagers. It’s thought that at least half of all children have them. They sometimes happen because of fever or infection, and they usually disappear when your child is well again.Abnormal heart murmurs are more serious. They’re often caused by congenital heart disease. These murmurs can be either present from birth or happen later in life.Symptoms of heart murmur in children. If your child has an innocent heart murmur, they’ll have no symptoms at all.If your child has an abnormal heart murmur, they might have symptoms related to heart disease. These might include breathlessness and blueness of the lips, fingers and toes. If the murmur is present from birth, these symptoms might appear immediately or soon after the birth.You can’t hear a heart murmur without a doctor’s stethoscope.Does your child need to see a doctor about heart murmur?Any problems with your baby’s heart are likely to be picked up at birth, when the midwife or paediatrician checks your baby. If problems aren’t detected then, they’ll probably be picked up in checks during your baby’s 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 you’re concerned your child is very unwell.Tests for heart murmur. If your doctor has any concerns about your child’s heart murmur, the doctor might order an ECG and a chest X-ray.The doctor might also refer your child to a cardiologist, who might do an echocardiogram.Heart murmur treatment. An innocent heart murmur doesn’t need any treatment, because there’s nothing wrong with your child’s heart. It’ll most likely disappear with time as your child grows.If your child has heart disease, they might need some form of treatment. This can range from medication to surgery, depending on what kind of disease it is and how bad it is. Some children just need regular check-ups with their cardiologist.
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TitlePediatric Heart Murmur
Urlhttps://www.childrens.com/specialties-services/conditions/heart-murmur
DescriptionHeart murmurs are extra or unusual sounds made by blood circulating through the heart or nearby blood vessels
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H1Pediatric Heart Murmur
H2What is a Pediatric Heart Murmur?
What are the signs and symptoms of a Pediatric Heart Murmur?
How is a Pediatric Heart Murmur diagnosed?
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Pediatric Heart Murmur Doctors and Providers
Frequently Asked Questions
Resources
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Could an innocent heart murmur become a problem as my child grows up?
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Can heart murmurs damage my child’s heart?
H2WithAnchorsWhat is a Pediatric Heart Murmur?
What are the signs and symptoms of a Pediatric Heart Murmur?
How is a Pediatric Heart Murmur diagnosed?
How is a Pediatric Heart Murmur treated?
Pediatric Heart Murmur Doctors and Providers
Frequently Asked Questions
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BodyPediatric Heart Murmur Abilene. 214-456-1318 Dallas. 214-456-2333 Plano. 469-303-4300 Park Cities. 469-488-7000 Request an Appointment with codes: Cardiology (Heart Center) Refer a Patient Accepted Insurance Plans What is a Pediatric Heart Murmur? Heart murmurs are extra or unusual sounds made by blood circulating through the heart or nearby blood vessels. In many cases heart murmurs are not serious and do not affect a child’s health, but they can be part of a more serious condition. Many times, what sounds like a murmur is actually the sound of blood moving through the heart normally. Also known as “innocent murmurs,” these sounds come and go, such as when a child has a cold or the flu. Heart murmurs in babies and children aren't always serious. However, if your child’s heartbeat sounds unusual, it’s important to see a cardiologist to be sure. If your child does need treatment at all, the specialists at Children’s Health can help. Physicians at Children’s Health℠ are world-class subspecialists from UT Southwestern with years of experience caring for children with heart murmurs. Heart murmurs become more worrisome when a child also has structural heart problems or certain infections known to cause heart damage, such as endocarditis and Rheumatic fever. In these cases, an abnormal heart murmur is often the first noticeable symptom of a more serious heart condition. What are the signs and symptoms of a Pediatric Heart Murmur? If your child has innocent heart murmurs, he or she will not experience any symptoms. The extra sounds may come and go, but your child will eventually outgrow them. Abnormal heart murmurs also have no symptoms other than unusual sounds your doctor hears when listening to your heart. When children with an abnormal heart murmur start showing other symptoms, it’s time to see a cardiologist. Symptoms of other heart conditions include: Pale skin Heavy or rapid breathing Rapid heart rate Tiredness Difficulty feeding Poor growth How is a Pediatric Heart Murmur diagnosed? An abnormal murmur itself is not a disease. More importantly, it’s a sign that your child may need additional tests to diagnose the condition that may be causing it. We start with a comprehensive exam, which may include one or more diagnostic tests. Your child’s evaluation may include: Questions about growth, development, family history and any recent illnesses Careful examination of your child’s murmur, including its location, timing, the sounds it makes and whether it changes when your child changes position Rating your child’s heart murmur on a scale of 1 to 6, with 1 being very quiet and 6 very loud Sometimes a heart murmur is a sign that your child has a congenital heart defect. Tests for congenital heart defects include: Electrocardiogram (EKG) Chest X-ray Echocardiogram Transesophageal echocardiogram Cardiac catheterization Cardiac CT Cardiac MRI As one of the only accredited pediatric diagnostic testing labs in North Texas, specialists at Children’s Health is recognized for meeting the strictest standards for testing and diagnosing all forms of heart disease. Learn more about our cardiac imaging department. If tests show signs of a congenital heart defect, your child is in good hands. Children’s Health is one of few programs in the country providing comprehensive care for all forms of congenital heart disease from childhood to adulthood. How is a Pediatric Heart Murmur treated? The best treatment for an abnormal heart murmur often involves treating the underlying cause. Medications: Improve heart functioning or remove excess fluid Non-surgical procedures (cardiac catheterization): Fix structural heart defects, such as patching holes in your child’s heart or repairing narrow blood vessels Corrective surgery: Repairs or replaces damaged or nonfunctioning heart structures such as leaky valves or a hole in the heart With a large team of pediatric cardiology specialists, experts at Children’s Health expertly delivers treatments for all forms of congenital heart disease. Learn more about our cardiothoracic surgery and cardiac catheterization programs.   Pediatric Heart Murmur Doctors and Providers. David Fixler, MD Pediatric Cardiologist Frequently Asked Questions. Could an innocent heart murmur become a problem as my child grows up? No. In most cases, innocent murmurs go away as children grow older. Will my child need heart surgery? Not always. Sometimes, the condition causing your child’s heart murmur heals on its own. If your child has innocent murmurs, they won’t need any treatment at all. Children may need surgery if a severe heart defect is causing their murmurs. My child’s pediatrician heard murmurs and referred us to a cardiologist, but the cardiologist didn’t hear any murmurs. What happened? In some cases heart murmurs come and go – especially in young children. Your child’s cardiologist may ask you to come back another time to see if the murmur returns. Can heart murmurs damage my child’s heart? No. A heart murmur is simply a condition that exists when blood circulating through your child’s heart makes unusual sounds. Sometimes, a heart murmur is a symptom of an underlying condition such as congenital heart disease which may cause heart damage if left untreated. Resources. American Heart Association Society for Cardiovascular Angiography and Interventions National Heart Lung Blood Institute 8b872b52-569a-47f3-928f-694f3dff8ad4 Pediatric Heart Murmur
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TitleHeart Murmurs In Children | St. Louis Childrens Hospital
Urlhttps://www.stlouischildrens.org/conditions-treatments/heart-murmurs
DescriptionThe pediatric cardiologists at the St. Louis Children's Hospital Heart Center specialize in the treatment of heart murmurs and other congenital heart defects. Talk to a St. Louis pediatric heart specialist today
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Treatment
Complications
When to Call a Healthcare Provider
Key Points
Next Steps
Related Stories from The Pulse
H3COVID-19: Visit our COVID-19 Resource page for information about testing, vaccines and more
H2WithAnchorsOverview
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BodyHeart Murmurs Overview. Heart murmurs are extra or unusual sounds made by blood moving through the heart. Murmurs are graded on a scale of 1 to 6, with 1 being very faint and 6 being 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 heart cycle For more information regarding pediatric heart murmur services in St. Louis or to make an appointment, please call 314.454.5437 or 800.678.5437 or email us. Causes. Heart murmurs are common in normal, healthy children. These may be called innocent murmurs. Or a child may be born with a heart defect that causes a murmur. Other causes include: Infection Fever Low red blood cell count (anemia) Overactive thyroid gland (hyperthyroidism) Heart valve disease Symptoms. Children with innocent murmurs have no other symptoms except the abnormal heart sounds. A child with a heart murmur caused by a heart problem may have the following symptoms. They vary depending on the problem. Poor feeding, eating, or weight gain Shortness of breath or breathing fast Sweating Chest pain Dizziness or fainting (syncope) Bluish skin, especially of the lips and fingertips Cough Swelling (edema) of the lower legs, ankles, feet, belly (abdomen), liver, or neck veins The symptoms of heart murmur can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis. For more information regarding pediatric heart murmurs services in St. Louis or to make an appointment, please call 314.454.5437 or 800.678.5437 or email us. Diagnosis. The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. During an exam, the provider will listen to your child's heart with a stethoscope. If the provider hears an abnormal sound, he or she may refer you to a pediatric cardiologist. This is a doctor with special training to treat children with heart problems. Tests include: Chest X-ray. An X-ray creates images of the heart and lungs. Electrocardiogram (ECG). This test that measures the electrical activity of the heart. Echocardiography (echo). An exam that uses sound waves (ultrasound) to look at the structure and function of the heart. This is the most important test to find heart murmurs. Treatment. Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Many heart murmurs are normal, extra sounds in children with strong, healthy hearts. These children don’t need treatment. Some of these heart murmurs may go away on their own. If the murmur is from a congenital heart defect, treatment may include medicine, procedures, or surgery. If the murmur is from another condition, the heart murmur will usually lessen or go away once the condition is treated.   Complications. A heart murmur has no complications. But your child may have complications related to the condition causing the heart murmur. A child with a congenital heart defect may have poor growth and development, heart failure, or other serious problems. When to Call a Healthcare Provider. Call your child's healthcare provider if your child has any symptoms of heart disease such as: Trouble feeding or eating Doesn't gain weight normally Trouble breathing Faintness Rapid breathing or blue lips Blue legs or feet Passing out Tiredness or trouble exercising Chest pain Key Points. Heart murmurs are extra or unusual sounds made by blood moving through the heart. Many heart murmurs are harmless. Some heart murmurs are caused by congenital heart defects or other conditions. The healthcare provider hears a heart murmur when listening to your child's chest with a stethoscope. Next Steps. Tips to help you get the most from a visit to your child’s healthcare provider: Know the reason for the visit and what you want to happen. Before your visit, write down questions you want answered. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child. Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are. Ask if your child’s condition can be treated in other ways. Know why a test or procedure is recommended and what the results could mean. Know what to expect if your child does not take the medicine or have the test or procedure. If your child has a follow-up appointment, write down the date, time, and purpose for that visit. Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice. For more information regarding pediatric heart murmur services in St. Louis or to make an appointment, please call 314.454.5437 or 800.678.5437 or email us. View All Related Stories from The Pulse. Mom Docs Toddler Bad Breath: What Causes it and How to Fix it . Newborn baby breath can smell so sweet, but as they hit the toddler stage, sometimes their breath becomes rancid. What ... Mom Docs New Year’s Resolutions: Helping Your Kids Set Goals . The New Year can be an exciting time full of opportunities for new beginnings and growth. The advent of each ... Mom Docs Popular Products Parents Can Skip: Advice from a Pediatrician . At this time of year, the internet is full of lists of “Top 5 recommended products.” So let’s flip the ... Mom Docs Babysitter Checklist: Everything to do Before Hiring a Babysitter . 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TitleInnocent (Harmless) Heart Murmurs in Children | Cardiology | JAMA | JAMA Network
Urlhttps://jamanetwork.com/journals/jama/fullarticle/1217241
DescriptionA murmur is the sound of blood flowing through the heart and the largeblood vessels that carry the blood through the body. Murmurs can be a sign of a congenital
Dateby AR Punnoose · 2012
Organic Position17
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BodyInnocent (Harmless) Heart Murmurs in Children | Cardiology | JAMA | JAMA Network Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue [Skip to Navigation]
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TitleHeart Murmur - Children's Hospital Colorado
Urlhttps://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/murmurs/
DescriptionHeart murmurs are very common, occurring in up to 70% of kids by the time they are school age. Most murmurs are not a cause for concern and do not affect a ...
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TitlePediatric Heart Murmurs: Evaluation and management in ...
Urlhttps://journals.lww.com/tnpj/fulltext/2011/03000/pediatric_heart_murmurs__evaluation_and_management.6.aspx
DescriptionIn the pediatric population, there are four common innocent heart murmurs: Still murmur, pulmonary flow murmur, systolic flow murmur, and the venous hum. These ...
Dateby L Wierwille · 2011 · Cited by 10
Organic Position19
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TitleHeart murmurs in children | The BMJ
Urlhttps://www.bmj.com/content/340/sbmj.c2737
Description
Dateby E Hoyles · 2010
Organic Position20
H1Heart murmurs in children
H2What exactly are you hearing?
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BodyHeart murmurs in children BMJ 2010; 340 doi: https://doi.org/10.1136/sbmj.c2737 (Published 15 June 2010) Cite this as: BMJ 2010;340:c2737 Article Related content Metrics Responses Peer review Elisabeth Hoyles, fourth year medical student1, Adam Lomas, fourth year medical student1, Obed Onuzo, consultant paediatric cardiologist21Cardiff University2University Hospital of WalesHow to distinguish between innocent and pathological murmursPaediatric murmurs are a common presentation on routine examination and are the leading cause for referral to paediatric cardiologists.1 Most are innocent.2 Murmurs that signify an underlying pathology are the most common way to detect children with potentially life threatening congenital heart disease and must be carefully considered.3Clinical examination is the cornerstone of diagnosis because complementary tests—for example, echocardiograms—rely heavily on the clinician’s direction to be sensitive and effective.4 So to manage the patient appropriately junior and other doctors must be confident in distinguishing between innocent and pathological childhood murmurs. However, despite the likelihood of coming across a child with a murmur in the acute setting or the community, junior doctors do not receive sufficient training to accurately assess them, although they will be expected to.5What exactly are you hearing?A murmur is a prolonged sound heard on cardiac auscultation caused by the turbulent flow of blood through the chambers of the heart and great vessels. This may occur in normal hearts and need not be the result of some structural abnormality. When evaluating a murmur adopt a systematic approach—for instance, when the cardiac output is high during a fever. A systematic approach will help you decide whether a murmur is likely to be innocent or pathological (table⇓).View this table:In this windowIn a new windowInnocent and pathological heart murmursTiming—Firstly, determine whether the murmur is heard in systole or diastole or continuously. A continuous murmur begins in systole but carries on through the second heart sound into diastole. Next, does it occur during one part of the phase (early, middle, or end—and if so which?), or does it last throughout (pansystolic or pandiastolic). If heard only during a part of systole, it is likely to be an ejection systolic murmur (also termed a … View Full Text Log in. Log in using your username and password. Log in through your institution. Subscribe from £157 *. Subscribe and get access to all BMJ articles, and much more. Subscribe* For online subscription Access this article for 1 day for:£30 / $37 / €33 (excludes VAT) You can download a PDF version for your personal record. Buy this article Back to top
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Urlhttps://www.uptodate.com/contents/approach-to-the-infant-or-child-with-a-cardiac-murmur
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TitleHeart Murmurs | American Heart Association
Urlhttps://www.heart.org/en/health-topics/heart-murmurs
DescriptionInnocent heart murmurs are sounds made by blood circulating through the heart’s chambers and valves, or through blood vessels near the heart. Innocent murmurs are common in children and are harmless
DateFeb 11, 2021
Organic Position23
H1Heart Murmurs
H2"Innocent" heart murmurs
Heart Insight® e-news
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Heart Insight® e-news
BodyHeart Murmurs Your doctor listens to your child’s heart with a stethoscope to detect heart murmurs. "Innocent" heart murmurs. Innocent heart murmurs are sounds made by blood circulating through the heart’s chambers and valves, or through blood vessels near the heart. Innocent murmurs are common in children and are harmless. These heart murmurs are also called “normal” or “physiological” murmurs. Innocent heart murmurs are so common that most children are likely to have one at some time. Innocent murmurs may disappear and then reappear. When a child’s heart rate changes, such as during excitement or fear, these innocent murmurs may become louder or softer. This still doesn’t signal that the murmur is cause for concern. If your doctor hears a murmur when listening to your child’s heart, they may recommend additional testing, such as an electrocardiogram (ECG) or echocardiogram (echo). This is to confirm the murmur is innocent. Unless testing suggests otherwise, no additional steps are needed. With an innocent heart murmur, your child won’t need medication, and doesn't have a heart problem or heart disease. You will not need to restrict your child’s activities or diet. They can lead an active, healthy life! Most innocent murmurs disappear when a child reaches adulthood, but in some adults the murmur remains for life. Read more about innocent murmurs. Other causes. Non-innocent (or abnormal) heart murmurs are often caused by defective heart valves. For example, a stenotic heart valve has a smaller-than-normal opening and can’t open completely. Or a valve may also be unable to close completely. This leads to regurgitation, which is blood leaking backward through the valve when it should be closed. Certain congenital defects and other conditions such as pregnancy, fever, anemia or thyrotoxicosis (a condition caused by an overactive thyroid gland) can also cause murmurs. A murmur that occurs when the heart muscle relaxes between beats is called a diastolic murmur. A systolic murmur occurs when the heart muscle contracts. Systolic murmurs are graded by intensity (loudness) from 1 to 6. A grade 1 is faint, heard only with a special effort. It's softer than the normal heart sounds. A grade 6 is extremely loud, and can be heard with no contact between stethoscope and the chest. Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff. Last Reviewed: Feb 11, 2021 Heart Insight® e-news. Our monthly e-newsletter delivers helpful articles and the latest news for heart patients and their families. Subscribe today!
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TitleHeart Murmurs in Children: Kids Kare Pediatrics: Board Certified Pediatricians
Urlhttps://www.tnkidskare.net/blog/heart-murmurs-in-children
DescriptionA heart murmur is an extra noise produced by the heart, and this is heard by the doctor using a stethoscope. Heart murmurs are very common in infants and childr
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BodyHeart Murmurs in Children Kids Kare Pediatrics Blog Heart Murmurs in Children Tweet Have you been told that your child has a heart murmur? More likely, there is no need for concern because heart murmurs in children are very common and most of these are benign or innocent heart murmurs.  First of all, a heart murmur is an extra noise produced by the heart. Normally, when listening to the heart with a stethoscope, we can hear only the first and second heart sounds, which sounds like "lub-dub". An extra noise between the "lub" and the "dub" is a heart murmur. Heart murmurs can be heard even at birth and throughout childhood and the teenage years. When your doctor or healthcare provider tells you that the child's heart murmur is innocent, then that means the child's heart is normal.  Innocent heart murmurs are benign, which means that it does not cause any symptoms and does not affect the child's growth or physical activity. It also comes and goes, which means sometimes the doctor hears it during some visits but not at every visit, especially if it is very soft or faint. Innocent heart murmurs can be louder when there is fever or stress, but that is still not concerning.  Also, most of the innocent heart murmurs in children will disappear as they grow older. But remember that some adults will still have innocent heart murmurs. If a heart murmur sounds abnormal, then your child might need an evaluation by a pediatric cardiologist or a heart specialist for children.      Author Christopher Climaco, M.D. Pediatrician and Pediatric Cardiologist practicing in Cookeville, Tennessee, USA You Might Also Enjoy... Sleep Hygiene for Kids Sleep is just an important to your child’s health as nutrition and exercise. The amount and quality of sleep that kids get can affect their moods, behavior, and learning abilities. Establishing good sleep practices early is so important. COVID-19 Vaccines for Children As the COVID-19 pandemic continues in the US and the whole world, we are seeing more and more adults getting the COVID vaccine. We also need to have children vaccinated so that we can resume our normal lives. Headaches in Children Headaches in children are common. Lifestyle modifications can help to avoid the most common triggers for headaches. Parents should also be familiar with the rescue and preventive measures, such as medications. Summertime Safety Tips As the weather is warming up and we are spending more time outdoors there are some things we can do to make sure that our kids are enjoying summertime safely. Toddler Nutrition Toddlers are notorious for throwing their parents for a loop by all of a sudden becoming very picky eaters and having a sharp drop in appetite. Parents often worry their child isn't eating enough. Here we will uncover the reason for this abrupt change. Parent Tips for Teen Mental Health The teenage years are a difficult time for many and mental health issues often arise during these years. However, the past year has significantly increased the percentage of teens reporting feelings of anxiety and depression. Here's how we can help. ×
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TitleHeart Murmurs and Your Child
Urlhttps://www.rchsd.org/health-articles/heart-murmurs-and-your-child/
Description
Date
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H1Heart & Blood Vessels
H2Heart Murmurs and Your Child
Rady Children's Hospital-San Diego
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H3How the Heart Works
Diagnosing a Heart Murmur
What’s an Innocent Murmur?
Congenital Heart Defects
Common Heart Defects
H2WithAnchorsHeart Murmurs and Your Child
Rady Children's Hospital-San Diego
Connect with Rady Children's
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General Miscellaneous Nutrition & Fitness Center Para padres Personal Stories Play & Learn Center Pregnancy & Baby Pregnancy & Newborn Center Pregnancy Calendar Q&As Recipes School & Family Life Slideshows Special Needs Sports Medicine Center Summer Safety Videos Heart Murmurs and Your Child. Many parents fear the worst when their child is diagnosed with a heart murmur, but this diagnosis is actually extremely common. In fact, many kids are found to have a heart murmur at some point during their lives. Most murmurs are not a cause for concern and do not affect the child’s health at all. What exactly is a heart murmur? By itself, the term heart murmur isn’t a diagnosis of an illness or disorder. To better understand what it does mean, it’s important to know how the heart works. How the Heart Works. The normal heart has four chambers and four valves (which function like one-way doors). The two lower pumping chambers of the heart are called the ventricles, and the two upper filling chambers are the atria (singular is atrium). Here’s how blood moves in normal circulation: Blood that returns from the body to the filling chamber on the right side (the right atrium) is low in oxygen. This blood passes across a valve (the tricuspid valve) to the pumping chamber on the right side (the right ventricle) and then travels across the pulmonary valve to the lungs to receive oxygen. The oxygen-enriched blood returns to the filling chamber on the left side (the left atrium), then across a valve (the mitral valve) to the pumping chamber on the left side (the left ventricle). The blood is then pumped across the aortic valve out to the body through the aorta, a large blood vessel that carries blood to the smaller blood vessels in the body to deliver oxygen. Using a stethoscope, a doctor examines the heart by listening to the sounds it makes. The familiar “lub-dub” sound of a normal heartbeat is caused by the closing sound of the valves as the heart squeezes to push blood through the body. A heart murmur describes an extra sound in addition to the “lub-dub.” Sometimes these extra sounds are simply the sound of normal blood flow moving through a normal heart. Other times, a murmur may be a sign of a heart problem. Diagnosing a Heart Murmur. A murmur is heard during the heart listening exam, using a stethoscope held at different areas on the front of the chest as the heart beats. Heart murmurs can be heard in infants as well as older kids and teens. Of course, if the child is crying, uncooperative, or breathing loudly, it might not be possible to hear a murmur. It helps if the child is quiet when the doctor listens, since some heart murmurs are very soft. The doctor may have a parent help by calming the child or having the child sit in the parent’s lap during the exam. Heart murmurs are rated on a scale from 1 to 6 in intensity (loudness). Grade 1 is barely audible, whereas grade 6 is very loud. The doctor will note where on the chest the murmur is best heard, the characteristics of the murmur (for example, whether it’s harsh and high-frequency or soft and blowing), where it occurs in the heartbeat cycle, and whether it changes when your child changes position. After this initial discovery, the doctor may refer your child to a pediatric cardiologist for further evaluation. It’s not unusual for a murmur to be noticed during a checkup, even though none was heard before. Innocent murmurs tend to come and go, depending on a child’s heart rate, position during the exam, and the presence of fever. Some new murmurs might be a sign of a newly developed heart problem. And some heart problems present from birth (congenital heart problems) at first might not be severe enough to cause a murmur that can be detected during an exam. Because of the common misconception that all heart murmurs are serious, it’s important for parents to understand which type of murmur their child has and if it needs further evaluation. What’s an Innocent Murmur? The most common type of heart murmur is called functional or innocent. This diagnosis means the murmur is produced by a normal, healthy heart. It can come and go throughout childhood. It usually goes away on its own as the child gets older and doesn’t pose any health threat. Kids with innocent heart murmurs don’t require a special diet, restriction of activities, or any other special treatment. They do not need to take a dose of antibiotic before going to the dentist. Those old enough to understand that they have a heart murmur should be reassured that they aren’t any different from other kids. In other words, an innocent murmur is the sound of normal blood moving through a normal heart in a normal way. Just as we can sometimes hear the sound of air moving in an air duct or water flowing through a plumbing pipe, we can often hear the sound of blood moving through the heart even if there is not a heart problem. Congenital Heart Defects. Some murmurs can indicate a problem with the heart. If the doctor suspects something other than an innocent heart murmur, your child will see a pediatric cardiologist, who might order or perform additional tests, such as a chest X-ray, an EKG (an electrocardiogram), or an echocardiogram. An echocardiogram, or “echo,” is an ultrasound picture of the heart structures (chambers, walls, and valves). It records the motion of the blood through the heart and can measure the direction and speed of blood flow within the heart structures. About 1 out of every 100 babies is born with a structural heart problem, or congenital heart defect. These babies may show signs of their defect as early as the first few days of life or they may appear completely healthy until later in childhood. Some kids won’t show any symptoms beyond a heart murmur, while others will have symptoms that could be mistaken for other illnesses or disorders. Symptoms of a significant heart defect in newborns and infants can include: rapid breathing difficulty feeding blueness in the lips (called cyanosis) failure to thrive Symptoms in an older child or adolescent may be: fatigue difficulty exercising or doing physical activity chest pain Contact your doctor if you notice any of these symptoms. Congenital heart defects can be seen in chromosomal disorders such as trisomy 21 (Down syndrome) or might be associated with specific gene abnormalities. Babies with other birth defects may also have heart defects. Exposure to certain chemicals, including alcohol, or medications before birth can be associated with congenital heart disease. While some parents may have more than one child with a heart defect, most heart defects aren’t considered to be hereditary. In most cases, however, children with congenital heart defects have no known risk factors. Maternal health also plays a role. At a higher risk of having a baby with a heart defect are pregnant women who: contract rubella (German measles) have uncontrolled or poorly regulated diabetes have PKU (phenylketonuria, a genetic error of the body’s metabolism) Common Heart Defects. Several different categories of heart problems can cause heart murmurs. These include septal defects, valve abnormalities, abnormalities of flow between the heart chambers and the exits (outflow tract obstruction), and heart muscle disorders. Septal defects involve the walls (or septum) between the upper or lower chambers of the heart. A hole in the septum can result in blood flowing through it into the heart’s other chambers. This extra blood flow may cause a murmur. It can also make the heart work too hard and may cause the heart to enlarge. Some holes can be large enough to produce symptoms in addition to a heart murmur; others are smaller and may close on their own in time. Valve abnormalities are caused by heart valves that are narrow, too small, too thick, or otherwise abnormal. Valves that are misshapen don’t allow smooth blood flow across them, and this creates turbulent flow. Sometimes, abnormal valves may allow backflow of blood within the heart. Either condition will cause a murmur. Outflow tract obstruction might be caused by extra tissue or heart muscle that blocks the smooth flow of blood through the heart. Heart muscle disorders (cardiomyopathy) can make the heart muscle abnormally thick or weak. This can impair the heart’s ability to pump blood to the body normally. A heart murmur is an exam finding, not a disease. Your doctor and pediatric cardiologist can determine if the murmur is innocent (which means your child is perfectly healthy) or if there is a specific heart problem. If there is a problem, a pediatric cardiologist will know how to best take care of it. Reviewed by: Steven B. Ritz, MD Date reviewed: May 2013 Note: All information on KidsHealth is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor. © 1995 - 2022 The Nemours Foundation/KidsHealth. All rights reserved. Rady Children's Hospital-San Diego. 3020 Children's Way, San Diego, CA 92123 Main Phone: 858-576-1700 Customer Service & Referrals: 800-788-9029 Contact Us Contact Us Make a Donation Connect with Rady Children's. Newsletters Thank a Staff Member Thank a Nurse Make a Donation Rady Children’s Specialists of San Diego| Rady Children’s Hospital Foundation| Privacy Information / Forms| Nondiscrimination| DRA Notice| Accessibility| Disclaimer| © 2022 Rady Children's Hospital–San Diego
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TitleHeart Murmurs in Children - Children's Health Orange County
Urlhttps://www.choc.org/heart/heart-murmurs-in-children/
DescriptionHeart murmurs are extra or unusual sounds made by blood circulating through the heart's chambers or valves, or through blood vessels near the heart
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H1Heart Murmurs in Children
H2Helpful Facts About Heart Murmurs
H3What is a heart murmur?
What causes a heart murmur?
What are the different types of murmurs?
Do all murmurs signify heart disease?
What tests may be used to evaluate a heart murmur?
What is the treatment for a heart murmur?
H2WithAnchorsHelpful Facts About Heart Murmurs
BodyHeart Murmurs in Children Should you be worried if your child is diagnosed with a heart murmur? At least 50 percent of children have a heart murmur at some point during their life. Learn what a heart murmur is and how to distinguish normal murmurs from abnormal murmurs. What is a heart murmur? Murmurs are extra or unusual sounds made by blood circulating through the heart’s chambers or valves, or through blood vessels near the heart. What causes a heart murmur? Heart murmurs may be heard in a normal healthy heart of a child, or they may be caused by a number of factors or diseases, including: Defective heart valves Holes in the walls inside the heart (atrial septal defect or ventricular septal defect) Other structural congenital heart defects Fever Anemia (low blood counts). What are the different types of murmurs? Your child’s health care provider will evaluate a murmur based on several factors. Murmurs are analyzed for pitch, loudness, location and duration. They also are graded according to their intensity (on a scale of 1 to 6, with 1 being very faint and 6 being very loud). Types of murmurs include the following: Systolic murmur. A heart murmur that occurs during a heart muscle contraction or when blood is pushed out from the heart to the body. Diastolic murmur. A heart murmur that occurs during heart muscle relaxation between beats or when heart chambers are re-filling before the next contraction. Continuous murmur. A heart murmur that occurs throughout the cardiac cycle, during contraction and relaxation. Heart murmurs can change and be heard or not heard at different times. With some large heart defects, newborn babies may have a very faint or no murmur at all because of nearly equal pressures on both sides of the heart. In addition, murmurs may be inconsistent and difficult to hear in an infant who is agitated or crying. Thus, sometimes murmurs may be missed or not detected. For these reasons, your child’s doctor will listen and evaluate your child’s heart sounds multiple times throughout your child’s growth and development. Do all murmurs signify heart disease? No, not all heart murmurs mean heart disease. Sometimes, a murmur may be heard in a normal child as the strong, healthy heart pumps blood into the vessels. This is known as an “innocent murmur.” It usually resolves as the child grows. Murmurs can also be heard in a child with no heart disease but who has a fever or who is anemic; these murmurs often go away when the underlying problem is treated. What tests may be used to evaluate a heart murmur? Echocardiogram (Echo): An ultrasound procedure that evaluates the structure and function of the heart. An ultrasound generates pictures using sound waves. Learn more about echocardiogram. Electrocardiogram (ECG): A fairly quick and simple test using stickers placed on the chest that can detect and record the electrical activity of the heart. Learn more about electrocardiogram. What is the treatment for a heart murmur? Many heart murmurs are normal, extra sounds in children with strong, healthy hearts. These children require no treatment. Some of these heart murmurs may resolve over time. Even if there is a hole or structural defect found in the heart, it may close as your child grows. However, some defects will require surgery to correct. Others are caused by conditions not related to the heart, such as having a fever or anemia. In these cases, the heart murmur will lessen or resolve as the underlying condition is treated. Helpful Facts About Heart Murmurs. Check out these helpful facts about heart murmurs in children from Dr. Nita Doshi, pediatric cardiologist at CHOC. Learn more about heart murmurs with Dr. Doshi.                  CHOC is affiliated with theUC Irvine School of Medicine CHOC LINKS Contact Us Directions Locations Pressroom Careers Giving I WANT TO... Find a Doctor Refer a Patient Pay My Bill Request Medical Records Access CHOC Link Volunteer LEGAL Privacy Notice Patient Rights Social Media Guidelines Notice of Nondiscrimination Other Policies Language Assistance: Español | 繁體中文 | Tiếng Việt | Tagalog | 한국어 | Հայերեն | فارسی | Русский | 日本語 | العربية | ਪੰਜਾਬੀ | ខ្មែរ | Hmoob | हिंदी | ภาษาไทย ©2022 CHOC 1201 W La Veta Ave, Orange, CA 92868 | Phone: 714-997-3000 | www.choc.org | A 501(c)(3) Organization
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Title3 common innocent murmurs in children - Pediatric Heart Specialists
Urlhttps://pediatricheartspecialists.com/heart-education/blog/66-3-common-innocent-murmurs-in-children
DescriptionPediatric Heart Specialists represent a group of physicians dedicated to the treatment of heart disease in children
DateJan 28, 2016
Organic Position27
H13 common innocent murmurs in children
H2Job Opportunities at Pediatric Heart Specialists!
H3Still's murmur
Pulmonary flow murmur
Cervical venous hum
H2WithAnchorsJob Opportunities at Pediatric Heart Specialists!
Body3 common innocent murmurs in children Details Published: January 28 2016 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 (a hole in the wall separating the lower 2 chambers of the heart) 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. Let’s review 3 relatively common innocent heart murmurs found in children. Still's murmur . Named for English pediatrician George Frederic Still, the Still's murmur is by far and away the most common innocent heart murmur. Many textbooks describe it as a vibratory type noise. I'm not sure myself if this is completely accurate, but at least that's the way it is frequently described. Certainly it is a very unique noise. Once you've heard a Still's murmur several times, it becomes very difficult to confuse it with anything else. I hear Still's murmurs at every age. I've heard it in babies a few hours old all the way up to full grown adults. I really think that this murmur can be present at pretty much any age. Classically it is most common in school aged children. It's a very distinct noise that is best heard along the left sternal border. Some experts feel that it might be more prominent in the flat position as opposed to sitting or standing, but I have not always found this to be the case. The cause of the Still's murmur is not entirely clear. Some studies have demonstrated that children with a Still's murmur are more likely to have an accessory mitral valve chord attaching to the ventricular septum (termed a “false tendon”). The chordae tendineae anchor the papillary muscles to the mitral valve leaflets. Occasionally there may be a stray chord that extends from a papillary muscle directly to the ventricular septum. Some experts think that vibrations of these anomalous chords are what produce a Still's murmur. In my opinion the Still's murmur is very unique. When a classic Still's murmur is present, it's hard to confuse it with anything else. Having said this, many children have slight variations in the sound or quality of the murmur which may suggest more worrisome causes. Rarely subaortic stenosis may be confused with a somewhat harsher Still's murmur. Subaortic stenosis can be caused by an isolated subaortic membrane, or can found in association with heart problems like hypertrophic cardiomyopathy. By far and away the Still's murmur is the most common innocent heart murmur. Determining the next most common innocent heart murmur is a little difficult. It all depends on what age you are talking about. Pulmonary flow murmur . A pulmonary flow murmur is just like it sounds. In a pulmonary flow murmur, all you are hearing is normal blood flow across a normal pulmonary valve. Blood is a liquid, and it flows through the heart fairly rapidly in some cases. Sometimes this normal flow can produce extra sounds or noises. The pulmonary valve happens to be one of the most anterior structures in the chest. In other words, it is fairly close to the chest wall. Therefore it makes sense that you might be able to hear normal flow across this valve compared to the other valves in the heart, which are farther back in the chest. Pulmonary flow murmurs can be heard at any age. They tend to be especially common in older children and teenagers. As you might expect, they are more common in kids who have thin chest walls, where the heart may be physically closer to the stethoscope and therefore easier to hear. Sometimes a pulmonary flow murmur can be confused with potential true heart disease. For example, an atrial septal defect might make a similar noise. Rarely mild pulmonary valve stenosis might also be confused with a pulmonary flow murmur. Cervical venous hum . A cervical venous hum is an extremely common type of innocent heart murmur. It is caused by the sound of blood flow returning normally through the veins above the heart. Specifically, the jugular veins drain blood from the head and neck and connect to larger veins which return to the heart. Sometimes a slight angle is produced in these connections which can create slightly turbulent blood flow. Usually this is the source of a cervical venous hum. Cervical venous hums are most commonly found in young school aged children. They're typically heard only in the sitting or upright position, because in this position gravity is exerting a stronger effect pulling blood down towards the heart. It's very uncommon to hear a cervical venous hum in a child who is laying flat. Exerting light pressure over the veins of the neck or having a child turn his head to one side can compress the veins somewhat and often makes the murmur disappear. Innocent cervical venous hums may not be detected in many children simply because they are not always listened for. In my experience, however, it's possible to hear this murmur in almost any school age child if you listen closely enough. Cervical venous hums are different from pathologic murmurs in that they disappear in different positions and with different maneuvers. This helps differentiate them from a patent ductus arteriosus, which can produce a similar type noise but won't disappear with these maneuvers. Penn Laird II, M.D. Posted by Dr. Penn Laird Jr. on September 21st, 2014. Job Opportunities at Pediatric Heart Specialists! . View Jobs
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TitleA Clinical Approach to Pediatric Heart Murmurs - YouTube
Urlhttps://www.youtube.com/watch?v=9jprf1bBX10
DescriptionCreated by world-class clinical faculty, Learning in 10 (LIT) Reviews covers topics in the United States Medical Licensing Exam (USMLE) Step ...
DateApr 21, 2020
Organic Position28
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TitleHeart murmurs | Children's Wisconsin
Urlhttps://childrenswi.org/medical-care/herma-heart/conditions/heart-murmurs
DescriptionHeart murmurs are sounds made by blood as it flows through the heart or blood vessels near the heart
Date
Organic Position29
H1Heart murmurs
H2In this section
Herma Heart Institute
What causes a heart murmur?
What are the different types of murmurs?
Do all murmurs signify heart disease?
Caring for children with heart murmurs
H3Types of murmurs include the following:
Among the nation's best
H2WithAnchorsIn this section
Herma Heart Institute
What causes a heart murmur?
What are the different types of murmurs?
Do all murmurs signify heart disease?
Caring for children with heart murmurs
BodyHeart murmurs Heart murmurs are sounds made by blood as it flows through the heart or blood vessels near the heart. Most of the time a heart murmur is just the normal sounds of blood flow, but sometimes it can indicate that there is a heart problem. Heart murmurs? Get a Heart Check What causes a heart murmur? . Heart murmurs may be caused by a number of factors or diseases, including the following: Defective heart valves Holes in the heart walls Surgical repair of congenital (present at birth) heart defects Fever Anemia (a decrease in the red cells in the blood) What are the different types of murmurs? . Your child's physician will evaluate a murmur based on several factors. Murmurs are analyzed for pitch, loudness, and duration. They also are graded according to their intensity (on a scale of one to six, with one being very faint and six being very loud). Types of murmurs include the following: . Systolic murmur - a heart murmur that occurs during a heart muscle contraction. Systolic murmurs are divided into ejection murmurs (due to blood flow through a narrowed vessel or irregular valve) and regurgitant murmurs. Diastolic murmur - a heart murmur that occurs during heart muscle relaxation between beats. Diastolic murmurs are due to a narrowing of the mitral or tricuspid valves, or regurgitation of the aortic or pulmonary valves. Continuous murmur - a heart murmur that occurs throughout the cardiac cycle. Murmurs related to a congenital (present at birth) heart defect or other problem involving the heart structures will be heard the loudest in the area of the chest where the problem occurs. Do all murmurs signify heart disease? . Not all heart murmurs are symptoms of heart disease. Many children have what is known as an innocent murmur. These murmurs are not related to congenital heart defects, and usually resolve by the time a child reaches adulthood. If your child's physician hears an innocent murmur, he/she may want to perform additional tests to ensure a heart defect is not present. A child with an innocent murmur can live a normal life and be as active as any other healthy child. Sometimes, a murmur may be heard in a normal child who has a fever or who is anemic; these murmurs often go away when the underlying problem is treated. Caring for children with heart murmurs. Pediatric cardiologists at Children’s are experts at diagnosing the cause of heart murmurs. If fever or anemia is to blame, treating the conditions medically may result in disappearance of the murmur. If your child has an innocent murmur, it is likely that no treatment beyond routine monitoring will be needed. Surgery may be required if a congenital heart defect is discovered. Herma Heart Institute has the most experienced and the only board-certified congenital heart disease surgeons in Wisconsin. Pediatric heart surgery As one of the busiest pediatric heart surgery centers in the country, our Herma Heart Institute performs hundreds more operations than any other program in the state. Explore Our Heart Surgery Expertise Let us help you Coming from out of town? Traveling with a sick child to a new city can be stressful. We can make your visit to our hospital as easy as possible. Traveling here locally? Contact us for more information about the Herma Heart Institute. Request an appointment online or call (414) 607-5280 or toll-free (877) 607-5280. Nationally recognized Among the nation's best . U.S. News & World Report has once again ranked the Herma Heart Institute at Children's Wisconsin among the top programs in the nation for pediatric cardiology and heart surgery. This ranking reflects the excellent outcomes and care we provide for even the most complex heart conditions. Families travel from across the country, and even around the world, to receive care from our specialists who are experienced in treating congenital heart disease from before birth and into adulthood. Read the Report
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TitleHow Serious Are Heart Murmurs in Children? – Cleveland Clinic
Urlhttps://health.clevelandclinic.org/how-serious-are-heart-murmurs-in-children/
DescriptionAre heart murmurs dangerous, and what do they say about a child's heart? A pediatric cardiologist explains
DateOct 29, 2020
Organic Position30
H1How Serious Are Heart Murmurs in Children?
H2Health Library
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Q: How serious are heart murmurs for kids?
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Does a Bad Night’s Sleep Affect Your Health?
How Serious Are Heart Murmurs in Children?
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BodyHow Serious Are Heart Murmurs in Children? The short answer from a pediatric cardiologist Share Facebook Twitter Linkedin Pinterest email Email Q: How serious are heart murmurs for kids? A: A heart murmur is an extra sound heard when listening to the heart. They are very common in children. Advertising Policy Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy We pediatric cardiologists spend lots of time learning to listen to heart murmurs with a stethoscope. The quality of a murmur tells us a lot about the cause. Murmurs that sound soft or vary with the position of the child tend to be what we call innocent, or functional. In these cases, we can simply hear the sound of blood flowing through the heart. These types of murmurs can sound louder at times of illness or stress. Children generally grow out of these murmurs as they get older. Murmurs that have a harsher quality can sometimes indicate an underlying heart valve or heart muscle problem. Advertising Policy We also listen for: Pitch: Is the tone higher or lower than it should be?Timing: Does the murmur occur when the heart is squeezing or relaxing?Volume: How loud is it? A loud murmur may suggest an underlying heart problem. (You can hear really loud murmurs without a stethoscope and even feel them with your hand.)Subtle clicks: These suggest abnormalities with how a valve opens or closes.  Abnormal heart murmurs range in severity. For some murmurs, the doctor may simply monitor children over time. For others, medication or surgery may be required. —Pediatric cardiologist Holly Nadorlik, DO Advertising Policy Advertising Policy Related Articles. May 7, 2019 / Pediatrics May 7, 2019 / Pediatrics Hear, Hear! How to Protect Your Child’s Ears From Sound-Induced Hearing Loss . January 29, 2019 / Pediatrics January 29, 2019 / Pediatrics How to Handle Your Child’s Lying at Every Age . December 13, 2019 / Heart Health December 13, 2019 / Heart Health Intense Gaming Can Trigger Syncope in Some Children and Teens . August 27, 2014 / Ear, Nose & Throat August 27, 2014 / Ear, Nose & Throat Should I Have My Child’s Hearing Tested? . March 2, 2016 / Brain & Spine March 2, 2016 / Brain & Spine Would You Know If Your Child Was Having a Stroke? . December 31, 2020 / Heart Health December 31, 2020 / Heart Health Can You Play Sports With a Heart Murmur? . Trending Topics. 1 7 Health Benefits of Turmeric . 2 Is TikTok Causing Tics in Teen Girls? What Parents Need to Know . 3 Does a Bad Night’s Sleep Affect Your Health? . Facebook Twitter YouTube Instagram LinkedIn Pinterest Snapchat Share this article via email. 1 / 2 2 / 2 Left Arrow Previous Right Arrow Next How Serious Are Heart Murmurs in Children? Are heart murmurs dangerous, and what do they say about a child’s heart? A pediatric cardiologist explains.
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  • 30
  • advertising
  • 5
  • 30
  • policy
  • 5
  • 30
  • pediatric cardiologist
  • 4
  • 30
  • advertising policy
  • 4
  • 30
  • heart health
  • 4
  • 30
  • ear
  • 4
  • 30
  • cardiologist
  • 4
  • 30
  • hear
  • 4
  • 30
  • december
  • 4
  • 30
  • time
  • 3
  • 30
  • loud
  • 3
  • 30