When to worry about children’s heart murmurs?

“The child has a heart murmur.” When parents hear these words during their child’s cardiological visit, they inevitably worry a lot. Yet many babies and children have heart murmurs without having any heart disease, which is why it is called “innocent” or “functional”. And it is actually not uncommon for one to examine the family history of the child with an innocent heart murmur that it turns out that within the family there are other subjects who also have the nausea and have excellent health. Here’s when to worry about children’s heart murmurs with advice from Dr. Fabrizio Drago, Head of the Cardiac and Arrhythmology Complex Operating Unit at the San Paolo, Palidoro and Santa Marinella offices at Bambino Gesù Pediatric Hospital.

What is heart murmur in babies?

Heart murmurs affect more than 70% of children and in most cases disappear spontaneously with growth. Only in a small percentage of cases is it due to heart disease: in this case it is defined as “organic” or “pathological”, and it will be the pediatrician with the help of a pediatric cardiologist to frame the condition and identify the best solution for the little patient.

If it can be frightening to hear that mentioned, it is good to know that the murmur in the heart is by no means a disease but a special noise produced by the blood flowing in the heart and perceived by the pediatrician or cardiologist by to listen to the heart muscle with phonendoscope (the tool used by doctors to evaluate the function of the heart and lungs).

What can cause heart murmurs?

Blood typically flows quietly and silently into the heart cavities (atria and ventricles), through the heart valves and into the arteries connected to the heart (it can be compared to the course of a stream that runs slowly and unhindered), and therefore no murmur is detected by auscultation of the heart muscle . However, it can happen that the blood flow becomes restless and faster, and that by flowing at high speed and in a more turbulent way, it causes precisely the breathing (like a stream that flows quickly downhill or encounters obstacles along the way).

What is the innocent heartbeat?

The innocent or functional breathing is due to the noise produced by the blood, which flows in the heart and has special characteristics: it is sweet and / or musical, tends to low intensity, varies in the different phases of breathing and according to the position taken of the child (in the upright position is usually absent) and is not associated with other symptoms.

The innocent or functional heart murmur in the pediatric population is very common: it is actually found in a percentage between 50 and 90% of children between 3 and 7 years (the period when the incidence is highest). Among the factors that predispose to the development of the innocent murmur is certain age: young children actually have a higher heart rate than adults and greater contractility, which can lead to increases in blood flow rate, which in turn can cause small turbulences, which gives life to the breath. But even the onset of some pathologies – which have nothing to do with the cardiovascular system – can provoke the presence of an innocent or functional heart murmur. Among the most common are:

  • fever, which causes an increase in heart rate;
  • anemia: the blood reaches greater flow rate because it is less dense;
  • hyperthyroidism, whose symptoms often include an increase in heart rate.

With the cure of the diseases that caused it, as well as with the growth, the innocent breathing is no longer heard.

When to worry about children’s heart murmurs?

In the vast majority of cases, the heart murmur in children represents a benign condition – that is, it does not involve any problem – and transient, that is, it tends to disappear spontaneously with growth. Sometimes, however, it can be a sign of the presence of real anomalies in the anatomical structure of the heart: in this case, we are talking about “organic” or “pathological” heart murmur.

Heart disease present from birth. These anomalies may be due to congenital malformations or changes, ie. present from birth, from the structure or function of the heart valves (valvulopathies), from the walls that act as partitions in the heart chambers (atrial or interventricular defects) or problems related to the heart muscle (cardiomyopathies). While the pathological malaise in most cases is due to congenital heart disease (congenital heart disease), it can rarely be caused by certain diseases (such as rheumatic disease) that can affect a previously healthy heart (acquired heart disease).

Fatigue, weakness, loss of appetite. Unlike the innocent or functional, the pathological discomfort is often accompanied by symptoms that become clearer the more severe the problem, such as fatigue, loss of appetite, increased breathing and heart rate, intolerance to exertion, bluish color of the skin, poor growth (especially noticeable in younger children).

How do you know if you have a heart problem?

To distinguish an innocent heart murmur from a pathological one, the experience of the doctor visiting the child is usually sufficient: pediatric cardiologists, but also expert pediatricians, by listening to many heart murmurs in even young children are usually able to understand the type of breathing , found to be detected.

Tone, intensity and duration. The physician primarily assesses the murmur detected by auscultation with the stethoscope, paying particular attention to the tone of the murmur (which may be acute, moderate or severe), intensity, duration, irradiation (ie in which part of the breast may be heard) and finally to any changes in respiration depending on breathing, posture and physical activity.

Other symptoms. During the visit, he then asks for information about the presence of any health problems in close family members of the child and examines the presence of other symptoms manifested by the little patient: such as growth retardation, eating problems, episodes of bluish skin, mild fatigue. It is rarely necessary to have the child undergo specialist examinations such as an electrocardiogram or echocardiogram.

If the physician is not able to reliably recognize the murmur as innocent or pathological, he prescribes a cardiological examination with an electrocardiogram. The electrocardiogram (abbreviated ECG) is a simple and non-invasive examination that allows you to record and graphically view the electrical activity of the heart by attaching electrodes to the skin in some places on the body, recording the rate of rhythm and any irregular heartbeat. As needed, it can be performed at rest, with the patient lying on the bed or under stress while the patient walks on the treadmill or pedal on an exercise bike.

In summary

How can one understand that you have the murmur in your heart?

A cardiological specialist visit is not necessary to detect the presence of heart murmurs: the pediatrician may notice it during a routine check-up, as auscultation of the chest and heart with a telephone doscope is the basis of each visit.

In any case, when the malformation is a sign of a serious heart malformation, it is usually detected immediately after birth or at most in the first weeks of life: therefore, if the baby was and has reached the age of more than 2 months at birth, the malformation is even it is pathological, not an expression of a serious congenital heart disease (ie present from birth), precisely because all children with severe congenital heart disease show symptoms no later than within the first two months of age.

When is an echocardiogram necessary?

Most of the time, the electrocardiogram is sufficient to clarify the doctor’s possible doubts about the possible presence of a heart defect. However, the cardiologist may find it appropriate to also subject the small patient to an echocardiogram, commonly referred to as an echocardio or echocheart, a non-invasive diagnostic test that is very similar to that used in normal examinations using an ultrasound probe. Ultrasound allows the doctor to visualize the shape and size of the heart and the associated blood vessels and get information about the function of the heart valves and cavities, atria and ventricles. Note, however: as the echocardiogram is a very accurate and very expensive instrumental examination, and since in children under three years sedation is often required for the performance, it is advisable that the prescription is performed by the specialist cardiologist, and not by the pediatrician, and is always supported by a well-founded diagnostic suspect

How to get rid of heart murmurs?

As the child gets older, the innocent murmur usually shrinks until it disappears because both the heart chambers and the chest become larger, and therefore the noise is more difficult to transmit to the outside. This does not mean that the breath is no longer there, but simply that it is no longer possible to detect it. In some people, it may remain even as adults: this means that in these subjects, simply, the sound produced by the blood flow in the heart is effectively transmitted from their chest.

The information on this site is not intended for and should in no way replace the direct relationship between healthcare professionals and the user. It is therefore advisable to always consult your doctor and / or specialists.

Leave a Comment