What is a Heart Murmur in Children? Symptoms, Causes, and Treatment

What is a Heart Murmur in Children? How is it Treated?

Heart murmurs are sounds heard as a swishing noise during a physical examination, caused by blood flow due to reasons such as holes in the heart, heart valve defects, or narrowing of heart vessels. Heart murmurs are sounds that can be frequently heard during examinations in almost every age group; however, they are more common in children. Heart murmurs in children can occur for various reasons, and these are sounds heard during the pumping of blood in the heart and as blood flows through the structures inside the heart.

Heart murmurs in children can occur when children have a febrile illness or without any specific reason. A heart murmur is not actually a disease. It is often discovered incidentally during an examination because it is a sound different from normal heart sounds. In cases where the murmur is potentially dangerous, other symptoms are also taken into consideration.

What is a Heart Murmur in Children?

As blood flows through the heart, it makes the classic “lub-dub” sound as it passes through the heart chambers. In children, a heart murmur occurs when blood flows in a turbulent manner as it passes through the natural structures of the heart during its normal function. It is slightly different from the normal heart sound, and some heard murmur sounds may lead your physician to suspect certain diseases. This is because the murmur sound created by these turbulent sounds is considered normal in some cases and abnormal in others in children.

What Are the Types of Heart Murmurs?

Heart murmurs in children sometimes follow a normal course, while in other cases, their intensity may increase. These murmurs are divided into three categories based on their timing:

Systolic Murmur: Occurs when the heart contracts.

Diastolic Murmur: Occurs when the heart relaxes.

Continuous Murmur: Heard during both the contraction and relaxation of the heart.

Heart murmurs in children can occur for various reasons. Sometimes they may manifest with certain symptoms. Some conditions that cause heart murmurs in children include:

Fever

Infection

Overactive thyroid gland (hyperthyroidism)

Low red blood cell count (anemia)

Heart valve diseases

Atrial Septal Defect (hole between the two upper chambers of the heart)

Ventricular Septal Defect (hole between the two lower chambers of the heart)

Some murmurs in childhood are considered normal and are called innocent murmurs. Others may result from defects in the heart's structures, which are called pathological murmurs and are not innocent. Pathological murmurs can be heard in congenital diseases such as VSD, ASD, PDA, or in cases such as heart valve defects or dilation of heart vessels. In the presence of such defects, blood passing through the natural structures of the heart can create a murmur sound. Sometimes, murmurs can also occur due to diseases that are not congenital but develop later. The most important of these are heart valve defects due to rheumatic fever. Unlike the symptoms seen in innocent murmurs, other signs and findings may be observed in children with pathological murmurs. Some of the diseases that can cause heart murmurs in children are:

VSD (Ventricular Septal Defect): Ventricular septal defect is the presence of a hole in the wall between the two ventricles of the heart. It is often diagnosed incidentally when visiting a doctor for any reason such as fever, cough, or fatigue.

ASD (Atrial Septal Defect): Atrial septal defect is the presence of a hole between the atria of the heart. In this case, oxygen-poor blood mixes with the clean blood coming from the lungs, causing a drop in the oxygen level in the blood.

PDA (Patent Ductus Arteriosus): In babies before birth, there is a vessel called the ductus arteriosus between the two main arteries in the heart. Normally, this vessel closes within the first 3 days after birth; however, it may not close in some babies. The risk is higher in premature births, but it may close with appropriate treatment or spontaneously within a few months.

Heart diseases are among the group of diseases that should never be neglected. If one or more of the mentioned conditions exist, you should not neglect to go to the nearest healthcare facility and seek expert support.

Hisar Hospital Intercontinental serves with heart centers where all procedures are performed. 2 of the 7 operating rooms within the hospital are reserved for children.

What is an Innocent Heart Murmur in Children?

Murmur sounds are graded by physicians from 1 to 6. In innocent murmurs, it is observed that the heart pumps in a normal way along with normal blood flow. Innocent murmurs in children are seen more frequently during situations such as febrile illnesses where the body is vulnerable, but they do not impose any restrictions on their lives and do not require any treatment or observation. In abnormal heart murmurs, there is an abnormal blood flow and an abnormal pumping situation, which requires examination with further tests.

Is a Heart Murmur Dangerous?

Murmurs are sounds produced as blood passes through certain areas of the heart during its operation and are noticed during an examination. Heart murmurs in children can be seen in two ways: normal or abnormal. Normal heart murmurs are sounds produced as blood circulates in the heart. It is normal to hear them throughout childhood, and they do not require any follow-up. Some murmurs are abnormal sounds that require close follow-up, and in such cases, your physician will refer you to a pediatric cardiologist. Whether murmurs are normal or abnormal can be determined by certain evaluations:

How loud the murmur sounds are,

Which of the heart chambers it is heard from,

Whether there is an abnormality in the heart sound according to the child's posture,

Evaluation is made based on which phase of the heart's operation the murmurs occur in.

After examining your child, the doctor will note the information regarding innocent murmurs and check for any changes in subsequent check-ups. If you change doctors, do not forget to convey the information given to you by your previous doctor to the new doctor. If your physician has not detected any abnormality in the murmurs, they will not require further follow-up. In cases of abnormality, if you are referred to an expert pediatric cardiologist, the likely diagnostic and imaging methods to be performed are:

Chest X-ray: Allows imaging of the heart and surrounding organs.

ECG: Reflects the electrical activity of the heart.

Echocardiography: Reflects the movements of the heart and blood flow with the help of sound waves.

Heart murmurs in children are usually considered normal, but sometimes a murmur can develop later. In some heart diseases, a murmur may not be seen.

What Are the Symptoms of a Heart Murmur?

During innocent murmurs, normal heart sounds are heard, and no additional symptoms occur. Some of the symptoms that may occur when a heart murmur in children is abnormal are:

Shortness of breath or rapid breathing,

Excessive sweating,

Chest pain,

Dizziness and fainting (syncope),

Bluish appearance, especially on the lips and fingertips,

Cough,

Swelling of the ankles, feet, lower legs, abdomen (belly), liver, or neck veins.

Frequently Asked Questions About Heart Murmurs in Children

Heart murmurs in children are a factor that can cause concern for parents and create some question marks in their minds. The answers to some of the most frequently asked questions about heart murmurs are explained below.

How can we tell if a heart condition is congenital or developed later?

Congenital heart diseases can manifest themselves with certain symptoms. They can be noticed during parents' observations and routine check-ups. Some of these symptoms are the baby getting tired while nursing, sweating, and not nursing in the newborn period, and the resulting weight loss, frequent breathing, cyanosis due to respiratory distress, getting tired easily, and palpitations.

At what age can my child with a heart murmur have surgery?

Innocent murmurs in children usually resolve spontaneously around the age of 7. In cases where they do not resolve, you can decide on surgery in cooperation with your physician as a result of the examinations performed. Depending on the child's condition, surgery can sometimes be performed immediately or sometimes it can be waited.

Is it possible to recover without surgery?

Heart murmurs in children are divided into two: innocent and pathological. If the murmurs are innocent, no further follow-up or treatment is required. In abnormal murmurs, it is decided what to do according to the child's condition. In some cases, a non-surgical method such as angiography is preferred, while in other cases, open-heart surgery may be resorted to. If the murmur in your child is pathological, it is likely that your child is tired, weak, and frail due to the heart disease causing the murmur. Ensuring that their vaccinations are complete, protecting them from infections, and close follow-up are important points to pay attention to during this process.

Should I take my child for a check-up even if they have no complaints or symptoms?

Heart murmurs in children can be learned incidentally during routine examinations in children, or they can be learned when going to the doctor as a result of certain symptoms. Even if your child does not have any symptoms, it is useful to show them to a physician. It should not be neglected as unknown diseases can also be detected during examinations.

Does a parent's heart condition pass to the child?

It is not exactly known why heart diseases occur in babies, but it can be said that genetic and environmental factors are effective. Heart murmurs in children can occur due to infections during pregnancy, alcohol and cigarette use during pregnancy, the presence of diabetes in the mother, and genetic factors.

How do I know if my child has a heart murmur?

Some murmurs in children are evaluated as a natural condition by experts. However, if there are symptoms such as shortness of breath, choking while exerting effort, rapid breathing, chest pain, sweating, and cyanosis of the skin along with coughing, you should consider that there may be a murmur and heart disease, and you should take your child to a physician as soon as possible.

Heart diseases bring great anxiety to parents. When such a situation occurs in your child and you go to a specialist, here are some tips that can help you with what you want to ask or other issues:

You should note down the questions you want to ask your physician before the appointment.

You should be well aware of the reason for your visit and your expectations from the visit.

You should write down the new diagnosis made during the visit, any medications, tests, and treatments if any. Also, write down the instructions your doctor gives you.

You should know the medications and their side effects when a new treatment is started or a medication is prescribed.

If your child is a follow-up patient, note the date, time, and purpose of the appointment.

You should be well aware of the purpose of the tests and treatments performed.

If your child is diagnosed with a heart murmur, know well the conditions that cause the murmur and what you need to do, and do not hesitate to get expert help.