Sooner or later almost every parent hears the phrase “heart murmur” – if not from a physician, then from a neighbor, relative or member of the PTA. McLeod Pediatric Cardiologist Charles Trant, Jr., M.D., sorts out the questions and, hopefully, reduce anxiety surrounding “heart murmurs:”
Here’s a summary of Dr. Trant’s comments:
The term “heart murmur” simply means that we are hearing a noise with a stethoscope. There are several different types of murmurs. There is one group we call functional murmurs, which means there is nothing wrong with the child. We are just hearing an extra sound. On the other hand, there is a large group of murmurs that are related to problems. Usually because either a valve in the heart isn’t working correctly or there is a hole in the heart. Some of those need to be fixed. Some can go away by themselves. So, the key is to determine the correct diagnosis. Then, we can talk about what we may need to do about the problem.
The physics of it is related to turbulence. The blood is going through something and it is getting churned up in a physiological way (and that is the normal kind of murmur). But if a valve is leaking, as the blood goes through that leaky section, it gets churned up just like we put a kink in a garden hose.
So, the murmur is something that we hear. The first step is we examine the child. We listen. If we hear the noise and decide that it could be a pathologic murmur, we do an echocardiogram and ultrasound of the heart. It shows me the walls, chambers and valves. Then I can pinpoint the cause of the problem
Murmurs by themselves don’t cause symptoms. A murmur is a finding that may be related to something else. And that something else could lead to heart failure or other things, which could make the child symptomatic. Most youth aren’t symptomatic when they come to me. Someone just heard a noise and the child is referred to me. Some of them still need surgery.
Is a murmur a signal of something bigger? It can be. Sometimes they are found incidentally. Found on a routine examination. Sometimes it’s found during a sports physical. The good news is that they will be fine. The bad news: some of them aren’t fine. So, we have to treat every patient as if there is something potentially wrong. We check it out. If the youth are OK, they can get back out on the field. If they aren’t OK, then they need to know that, too, so we can start treatment.
So, the disease associated with heart murmurs would be issues, such as valve problems. There are four valves in the heart. In pediatrics, two of the valves are more to prone to problems. The aortic valve and the pulmonary valve may be too tight or too leaky. Then there are four chambers in the heart, two on the top and two on the bottom. There is a wall a between the upper chambers and a wall between the lower chambers. Children can be born with holes in these walls. Some holes may be small enough that they will repair themselves. Some of them — either because of the size or the location — can’t fix themselves. We don’t want to fix them too soon. Sometimes it’s good to give the child a little time to see if he or she can outgrow it. Some of it we have to fix right away, because there is no chance it will fix itself. There is that scary place that is called “too late.” For various reasons, occasionally the young person didn’t get fixed when they were supposed to. The child is now a teen — is 16-years-old — with serious unfixable medical problems, because we didn’t fix it when we had the chance. So, all the more reason that if there is a problem, it’s OK to be scared. But it’s also OK to bring the kid in, let us check it out and make sure it’s not anything bad.
First, try not to panic. It might be one of those functional murmurs. Don’t go to the internet, because Doctor Google isn’t necessarily your friend. Then, if your pediatrician or family physician refers you to me, I will do the examination and, if needed, do the ultrasound. Then, we’ll talk about what we need to do.
If it’s a real problem, but it’s small, then sometimes we just follow them. Sometimes they will need medicine. If it’s a bigger problem, then most of them will need open heart surgery.