” My child has a heart murmur ?!’ is a statement from a worried parent when I informed them of this during a routine physical exam. As a parent, you may be alarmed hearing this from a Pediatrician, but I will explain more.

HOW DOES THE HEART WORK?

The heart is a muscle and powerhouse of the body. It works constantly every day of our lives to ensure adequate blood flow to the body’s organs.

There are 4 chambers of the heart: 2 on the left (i.e., Left atrium and left ventricle) and 2 on the right (i.e., right atrium and right ventricle). The heart valves connect the atria to the ventricles on each side, respectively, and the valves also connect the heart chambers to the large blood vessels connected to the heart.

The 2 on the right work to pump blood to the lungs via the Pulmonary Artery. This pumped blood receives oxygen from the lungs and returns to the left 2 chambers of the heart via the Pulmonary Veins. From the left chambers, the blood with oxygen is pumped out to the rest of the body via the Aorta (the body’s main artery).

WHAT ARE HEART MURMURS?

Heart murmurs are extra sounds heard between normal heartbeat rhythms. The normal heartbeat rhythm generally occurs in 2 phases and sounds like a lub-dub.

WHAT ARE THE TYPES OF HEART MURMURS?

There are 2 broad types of heart murmurs for the purpose of this discussion:  

1. Innocent or Functional Murmurs
2. Pathologic Murmurs

INNOCENT OR FUNCTIONAL HEART MURMURS

Innocent murmurs are common harmless extra heart rhythm sounds heard in children with normal heart anatomy.

Functional murmurs are due to increased blood flow in or to the heart. These murmurs may or may not be heard constantly and often get louder when a child is sick or excited. Innocent murmurs may disappear as a child grows or persist into adulthood.

Funtional murmurs do not progress into Pathologic murmurs.

Your child can participate in any sport without restrictions.

PATHOLOGIC HEART MURMURS

These are extra sounds in the heart due to defects in the heart’s structure. 

There are 2 broad categories of heart conditions that result in pathologic murmurs:

1. Congenital Heart Defects: these are heart defects present at birth.
2. Acquired Heart Defects: Heart defects that develop in a child over time. 

Pathologic murmurs are much less common. Less than 1% of heart murmurs in children are due to these.1

There are a myriad of causes of pathologic murmurs. Briefly, they are due to:

1.  Abnormal heart valves.
2.  Abnormal heart muscle thickness.
3. Abnormal blood vessels connected to the heart.
4. Abnormal connections between the heart chambers.

MANIFESTATIONS OF PATHOLOGIC MURMURS

. Shortness of breath.

. Difficulty breathing.

. Easily fatigued or tired. This manifests in a baby needing to stop feeding frequently to catch breath.

. Blue tint to lips, tongue, or nail beds, i.e., cyanosis.

. Poor growth.

. Excessive sweating while eating in babies.

. Swelling of the hands and feet.

. Difficulty feeding in babies.

. Fainting during exercises in older children.

. Heart palpitations.

. Chest pain. 

‘MY CHILD HAS A HEART MURMUR, ‘ WHAT NEXT?

. Innocent murmurs: no treatment is needed. These are benign conditions.

. Pathologic murmurs: need a Specialist, i.e., a Pediatric Cardiologist, to get an Echocardiogram and Electrocardiogram (ECG) and make management plans. A child with this condition may need frequent monitoring, sports activity restrictions, medications, or further care with the Pediatric Surgeons.

Discuss these conditions with your child’s pediatrician. 

1. Innocent murmurs. Biancaniello T. Circulation. 2005;111:20–22. [PubMed] [Google Scholar] [Ref list]

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