Cardiac Murmurs in the Pediatric Population
By Khalisa Syeda, DO – Dothan Pediatric Subspecialty Clinic
A cardiac murmur is an extra sound realized when listening to the heart with a stethoscope. As blood is pumped through the heart and passes through the valves, normal pumping sounds are heard, but an additional sound often indicates the presence of a cardiac murmur.
A murmur can be diagnosed in adults and children. Its presence does not always indicate the presence of cardiac disease. About two-thirds of school-age children may have a heart murmur. It is one of the most common reasons your pediatrician may refer you to a pediatric cardiologist.
The cardiac portion of the physical exam looks for early signs of cardiac disease. Congenital heart disease remains the most common birth defect, and there are various forms of acquired heart disease that may develop during a child’s lifetime. The identification and workup of a murmur is important. For most children with this finding, there is no cardiac disease. These cases are referred to as innocent or functional murmurs.
A pediatric cardiologist uses features of the murmur, such as location, timing, and quality, to determine the likelihood of underlying cardiac disease and will consider further testing with an EKG and ultrasound of the heart, or echo. Age is also important, as innocent murmurs are common in newborns and school-age children. Innocent murmurs are made louder by an exacerbating condition like dehydration, fever, infection, or acute illness, which may be when they are found.
There are certain features that can indicate the presence of cardiac disease. Loud or harsh murmurs, murmurs that change over time, and other abnormalities in the cardiac physical exam can be associated with cardiac disease and warrant a thorough evaluation. Features such as poor feeding, bluish discoloration, difficulty breathing, exercise intolerance, and passing out completely are other clues. These pathologic murmurs typically occur in less than 1 percent of the population and are not usually life-threatening.
Even if your pediatrician diagnoses your child with a murmur, he may not refer you to a cardiologist depending on the murmur’s features and the likelihood it will be an innocent murmur. It is not uncommon to be referred to a pediatric cardiologist for an expert opinion, and it does not mean your child has cardiac disease.
If your child is diagnosed with an innocent murmur, it is important to let future physicians examining your child know of this diagnosis and if a workup was performed. The identification and evaluation of the different types of childhood murmurs is a key part of the pediatric physical exam and remains one of the timeless ways to find congenital heart disease in children and adolescents.