Although the heart murmurs heard during the examinations of children alarm the families, the majority of these murmurs can be innocent. In innocent murmurs, the heart continues to function normally, while pathological murmurs may indicate an underlying heart condition. It is absolutely necessary to consult a pediatric cardiologist, especially in murmurs seen with symptoms such as bruising, developmental delay, low weight, sweating. From the Department of Pediatric Cardiology at Memorial Ankara Hospital, Prof. Dr. Feyza Ayşenur Paç gave important information about heart murmur in children.
Heart murmur is common in child
Murmur is the sound of blowing sounds, which are formed by the reflection of the turbulence of the blood flow in the heart and veins on the chest wall, with a listening instrument (stethoscope). Heart murmurs, which are among the most common findings in cardiac examination, can be classified according to their various characteristics; innocent murmurs are divided into functional murmurs and pathological murmurs.
Murmur detection is important in children’s examinations
Heart murmurs heard in children’s examinations may be a sign of an underlying heart disease; Most of them are innocent murmurs and some of them are functional murmurs. Innocent murmurs can be heard in 50-85% of healthy children. While innocent murmurs are sounds originating from a normal healthy heart, pathological murmurs are due to heart disease. Functional murmurs can also be heard in some conditions such as anemia.
Murmur can occur at any age
Although heart murmurs can be seen at any age, innocent murmurs can often be detected after 4-5 years of age. While pathological murmurs due to congenital heart diseases can be heard from birth, murmurs due to acquired diseases can occur at any age. However, there are also innocent murmurs heard in the newborn and infancy period.
Children often have an innocent murmur.
Innocent murmurs, which occur most often at the age of 4-5 years, can be heard louder in fever, running and other situations that increase heart rate. Since children are usually taken to the doctor when they are feverish, the murmur can be felt better in these examinations. The intensity of the innocent murmurs may increase in such cases, may decrease over time, disappear or continue in the same way.
Watch out for pathological murmurs!
Pathological murmurs, that is, murmurs due to underlying heart diseases, constitute a lesser proportion of murmurs heard in children. While these heart diseases may be congenital, there may also be acquired diseases in which permanent findings in the heart occur due to the effects of certain diseases on the heart. While murmurs are heard from birth in congenital heart diseases, murmurs in acquired (acquired) diseases can occur later at any age. For example, acute rheumatic fever can affect the heart and cause damage to the heart valves, aortic and mitral valve diseases and murmur. While acute rheumatic fever is a common condition between the ages of 5-15, the murmur appears after these ages. Another disease that affects the heart is Kawasaki disease. In addition, the heart is rarely affected in diseases such as juvenile rheumatoid arthritis and systemic lupus. In these diseases, murmur can be seen in the following period.
Attention to developmental delay and bruising accompanying the murmur!
More or less signs and symptoms may occur in children with murmurs related to the underlying cause. In some cases, the only finding may be a murmur. An important part of congenital heart diseases are intracardiac perforations and openings between great vessels. When these holes are small, they usually do not show symptoms, but they are noticed by a murmur during examination. When the heart holes are large, problems such as not gaining weight, feeding difficulties, breathing and frequent respiratory tract infections are seen.
In diseases such as tetralogy of Fallot and reversal of great vessels, bruising and breathing difficulties can be noticed. Beyond these, many more severe complex congenital heart diseases can be seen. In these heart diseases, symptoms such as bruising, shortness of breath, fatigue, feeding difficulties, and inability to gain weight can often occur. However, it should be kept in mind that in some important heart diseases, although very rare, the symptoms can be very insidious and this may lead to delays in diagnosis and treatment.
Genetic and environmental factors are important
Genetic and environmental interaction play a role in the formation of congenital heart diseases. Syndromic conditions, hereditary diseases and chromosomal abnormalities increase the risk. However, there is an increased risk of disease in those whose parents or siblings have congenital heart disease compared to those who do not. Acute rheumatic fever, which causes rheumatic valve diseases such as mitral and aortic valve diseases, is seen in those who have upper respiratory tract infection with beta hemolytic stereptekoc. Acute rheumatic fever, which is affected by environmental factors, is more common in crowded and low socioeconomic groups, and there is a possibility of recurrence due to its genetic predisposition.
Differential diagnosis of murmur needs to be made
The differential diagnosis of murmurs heard in children’s hearts must be made by a pediatric cardiologist. After the diagnosis, if necessary, follow-up and treatment planning should be done. Otherwise, there is a risk of entering into irreversible processes with the error of innocent murmur.
No treatment required for innocent murmurs
Since innocent murmurs are not signs of disease, they do not require treatment and do not affect the child’s life, physical and sports activities. In murmurs related to heart diseases, treatment and follow-up approaches vary according to the underlying cause. However, not all heart diseases that cause a murmur need to be treated. For example, small holes in the heart, mild valve stenosis and insufficiency do not require treatment. However, it should be followed for life in terms of side findings and complications that may occur throughout life.
If there is a significant heart problem, interventional or surgical methods are used.
Depending on the size of the hole in the heart, the amount of stenosis or leakage in the valve, some of these disorders are followed only by routine controls, and some are followed by drug treatments. In the case of clinically significant holes, stenosis, insufficiency and more important structural heart diseases, treatment with interventional or surgical methods should be planned and followed for life.
Source: (BHA) – Beyaz News Agency
