- What is a heart murmur?
- Types of heart murmur
- What causes a heart murmur
- How do you know if it is an abnormal heart murmur?
- Doctor visit and diagnosis
- Can heart murmurs be treated?
Lub-dub. Lub-dub. Lub-dub.
That’s how your child’s heart usually beats.
But sometimes, there’s an additional ‘whooshing’ sound that accompanies the lub-dub. That sound is called a ‘murmur’ (1). Heart murmurs are common in children, and in most cases, they are harmless and often never detected. However, sometimes these extra sounds can cause a disturbance in how the blood flows. Other times they indicate a heart problem. But, heart murmurs are rarely fatal.
Finding out that your child has a heart murmur can cause anxiety. But is a heart murmur something you should worry about? Keep reading as MomJunction tells you about the types, causes, symptoms, complications, and remedies of a heart murmur in children.
What Is A Heart Murmur?
The heart has four valves which open and close to let the blood into and out of the chambers. The ‘lub-dub’ is the sound of the valves closing. The heartbeat is actually made of two separate sounds. The first heart sound or S1 is made by the closing of the atrioventricular valves and the second heart sound or S2 is made by the closing of the semilunar valves (2).
The heartbeat is cyclic, which means it is in the form of S1 – S2 – S1 – S2… or lub-dub-lub-dub…
A heart murmur is an additional sound that is made between the heartbeats due to turbulent flow of blood (3). The sound is produced when a turbulence or disturbance is affecting the blood flow. The murmur is usually heard between the beats of the heart, which means the tiny gap between the ‘lub’ and ‘dub’.
A heart murmur is common in babies and children. More often than not, they are harmless. But in some cases, they may indicate a problem in how the blood flows to and from the heart or a disturbance in the blood vessels of the heart.
However, an abnormal heart murmur can be more serious than a normal heart murmur. Keep reading to know more about the types of heart murmurs in kids.
Types Of Heart Murmur
In general, there are two types of heart murmurs: functional or innocent heart murmurs and abnormal cardiac murmurs (4).
Innocent heart murmurs are most common ones in children. These heart murmurs indicate nothing but a smooth flow of blood through a healthy heart. However, just as you would hear the air in the water pipes at times, innocent heart murmurs are heard by the doctors. The murmurs can last through a person’s childhood, usually between ages three and seven, and tend to go away when the child gets older.
[ Read: Heart Rate In Children ]
Around 75% of all newborns and 66% of all children have normal or innocent heart murmurs (5). Common forms of innocent heart murmurs include:
- Still’s murmurs, which are the most common ones among children, are heard on the left side of the breastbone. These are difficult to hear or detect when the child is lying down or sitting.
- Pulmonic murmur is heard as the blood flows through the pulmonary artery.
- Venous Hum is heard when the blood flows through the jugular vein, near the collarbone. A doctor would have to check the child’s pulse at the collarbone to identify it.
Innocent heart murmurs tend to change in intensity based on how the child is positioned (sitting, lying down, or standing). Also, they are usually heard in one spot and do not move or radiate to other places such as the neck, armpits, or back.
When the heart murmur is caused due to a structural problem or congenital heart defects such as narrowed heart valves, a hole in the heart, or a leak in the heart valves, it is called an abnormal or pathological cardiac murmur. The cause of these murmurs varies from one person to another.
Heart murmurs can also be classified based on how they sound and when they occur during the cardiac cycle. You may come across terms such as:
- Systolic murmur in children is heard when a heart muscle contracts. Systolic murmurs can be ejection murmurs, which occur when blood flows through a narrow blood vessel or valve. Or they can be regurgitant murmurs that occur during mitral or tricuspid valve regurgitation when the blood leaks from the ventricles and flows back into the artery.
- Diastolic murmur occurs during the gaps between the beats of the heart. These murmurs may occur because of stenosis (narrowing) of the atrioventricular valves or regurgitation of the pulmonary or aortic valves.
- Continuous murmur occurs through the cardiac cycle.
The concept of murmurs may sound strange but there are reasons behind them.
[ Read: Panic Attacks In Children ]
Causes Of Heart Murmurs
Innocent heart murmurs are caused by the flow of blood to and from the heart. In children, abnormal or pathological heart murmurs can be caused due to congenital heart defects. These defects can be benign and may have no symptoms or complications. Or they can be severe and may need surgery or even a heart transplant.
Common causes of abnormal heart murmurs in children include (6):
- Anomalous pulmonary venous return or abnormal functioning of the pulmonary veins.
- Ventricular septal defect, which is a hole in the wall separating the right and the left ventricles of the heart.
- Atrial septal defect, a congenital heart condition, which is an abnormality of the wall that divides upper chamber of the heart.
- Patent ductus arteriosus, a condition where a blood vessel called the ductus arteriosus does not close.
- Coarctation of the aorta, which is narrowing of the aorta that makes it difficult for the blood to pass through the artery. This is a congenital heart defect as well.
Heart murmurs are not hereditary in nature. But a few heart conditions such as congenital heart disease and cardiomyopathy are hereditary and can cause heart murmurs (7). High blood cholesterol, which can also be hereditary, can worsen the murmurs (8).
These murmurs can be detected only by a medical professional, after a thorough diagnosis. The doctor will check for the symptoms and also recommend one or more diagnostic procedures to determine if the murmur is benign or severe. Learn more about them in the next section.
Symptoms of Heart Murmurs
Innocent heart murmurs do not usually have evident symptoms. In the case of an abnormal heart murmur, which could indicate an underlying heart problem, the symptoms or signs could be (4):
- Rapid breathing
- Pain in the chest
- Bluish color at the fingertips, usually seen in babies with congenital heart defects
- Swelling of ankles, feet, lower legs, neck veins, and abdomen
In most cases, however, a child may not show any symptoms of a heart murmur. Only a thorough diagnosis by a doctor can detect the murmurs.
[ Read: Chest Infection In Children ]
When To Visit The Doctor
If you find any of the above symptoms that indicate a severe heart murmur, take your child to the doctor. Also, it is imperative you get a professional opinion in case of:
- History of heart defects in the family: The chances of a child developing a heart problem, and thus a heart murmur, are higher if a blood relative has had them before.
- Medical history of the child indicates the presence of a heart murmur.
As the symptoms of murmurs are common with those of a few other conditions, the doctor will diagnose the exact condition.
Diagnosing Heart Murmurs In Children
The doctor would listen to the child’s heartbeat to detect any murmurs of the heart. Based on the examination, they can rate the murmur on a scale of 1 to 6, with one being very soft and six being very loud. After a thorough look at the individual and family medical history, the doctor may recommend a few more tests if needed. These may include:
- Chest X-ray
- MRI of the heart
- Cardiac catheterization
If the tests indicate a medical condition of the heart, the doctor will recommend appropriate treatment.
[ Read: Breathing Problems In Children ]
Treating Symptoms of Heart Murmurs
Children with innocent heart murmurs do not need any treatment, as they disappear and may reappear, but cause no harm (7). But if the heart murmur is due to a heart defect, the pediatrician may refer your child to a pediatric cardiologist. The treatment options for abnormal heart murmurs can include medications to prevent the formation of blood clots in the heart.
In rare cases, however, surgery may be required to correct the defect. But if the abnormal murmurs are caused due to other conditions such as fever and anemia, which are not related to the heart, no treatment is required.
Childhood murmurs are just an additional noise that is made when blood is pumped into the heart. In cases when it is due to a heart defect, there are treatment options. It helps to talk to a heart specialist if you suspect there is a problem.
[ Read: Pediatric Testicular Torsion ]
Have any tips on dealing with heart murmurs in children? Share them in our comments section.
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