Many parents fear the worst when their child is diagnosed with a heart murmur, but this diagnosis is actually extremely common. In fact, many kids are found to have a heart murmur at some point during their lives. Most murmurs are not a cause for concern and do not affect the child's health at all.
What exactly is a heart murmur? By itself, the term heart murmur isn't a diagnosis of an illness or disorder. To better understand what it does mean, it's important to know how the heart works.
The normal heart has four chambers and four valves (which function like one-way doors). The two lower pumping chambers of the heart are called the ventricles, and the two upper filling chambers are the atria (singular is atrium).
Here's how blood moves in normal circulation:
Using a stethoscope, a doctor examines the heart by listening to the sounds it makes. The familiar "lub-dub" sound of a normal heartbeat is caused by the closing sound of the valves as the heart squeezes to push blood through the body.
A heart murmur describes an extra sound in addition to the "lub-dub." Sometimes these extra sounds are simply the sound of normal blood flow moving through a normal heart. Other times, a murmur may be a sign of a heart problem.
A murmur is heard during the heart listening exam, using a stethoscope held at different areas on the front of the chest as the heart beats. Heart murmurs can be heard in infants as well as older kids and teens.
Of course, if the child is crying, uncooperative, or breathing loudly, it might not be possible to hear a murmur. It helps if the child is quiet when the doctor listens, since some heart murmurs are very soft. The doctor may have a parent help by calming the child or having the child sit in the parent's lap during the exam.
Heart murmurs are rated on a scale from 1 to 6 in intensity (loudness). Grade 1 is barely audible, whereas grade 6 is very loud. The doctor will note where on the chest the murmur is best heard, the characteristics of the murmur (for example, whether it's harsh and high-frequency or soft and blowing), where it occurs in the heartbeat cycle, and whether it changes when your child changes position. After this initial discovery, the doctor may refer your child to a pediatric cardiologist for further evaluation.
It's not unusual for a murmur to be noticed during a checkup, even though none was heard before. Innocent murmurs tend to come and go, depending on a child's heart rate, position during the exam, and the presence of fever. Some new murmurs might be a sign of a newly developed heart problem. And some heart problems present from birth (congenital heart problems) at first might not be severe enough to cause a murmur that can be detected during an exam.
Because of the common misconception that all heart murmurs are serious, it's important for parents to understand which type of murmur their child has and if it needs further evaluation.
The most common type of heart murmur is called functional or innocent. This diagnosis means the murmur is produced by a normal, healthy heart. It can come and go throughout childhood. It usually goes away on its own as the child gets older and doesn't pose any health threat.
Kids with innocent heart murmurs don't require a special diet, restriction of activities, or any other special treatment. They do not need to take a dose of antibiotic before going to the dentist. Those old enough to understand that they have a heart murmur should be reassured that they aren't any different from other kids.
In other words, an innocent murmur is the sound of normal blood moving through a normal heart in a normal way. Just as we can sometimes hear the sound of air moving in an air duct or water flowing through a plumbing pipe, we can often hear the sound of blood moving through the heart even if there is not a heart problem.
Some murmurs can indicate a problem with the heart. If the doctor suspects something other than an innocent heart murmur, your child will see a pediatric cardiologist, who might order or perform additional tests, such as a chest X-ray, an EKG (an electrocardiogram), or an echocardiogram. An echocardiogram, or "echo," is an ultrasound picture of the heart structures (chambers, walls, and valves). It records the motion of the blood through the heart and can measure the direction and speed of blood flow within the heart structures.
About 1 out of every 100 babies is born with a structural heart problem, or congenital heart defect. These babies may show signs of their defect as early as the first few days of life or they may appear completely healthy until later in childhood. Some kids won't show any symptoms beyond a heart murmur, while others will have symptoms that could be mistaken for other illnesses or disorders.
Symptoms of a significant heart defect in newborns and infants can include:
Symptoms in an older child or adolescent may be:
Contact your doctor if you notice any of these symptoms.
Congenital heart defects can be seen in chromosomal disorders such as trisomy 21 (Down syndrome) or might be associated with specific gene abnormalities. Babies with other birth defects may also have heart defects. Exposure to certain chemicals, including alcohol, or medications before birth can be associated with congenital heart disease.
While some parents may have more than one child with a heart defect, most heart defects aren't considered to be hereditary. In most cases, however, children with congenital heart defects have no known risk factors.
Maternal health also plays a role. At a higher risk of having a baby with a heart defect are pregnant women who:
Several different categories of heart problems can cause heart murmurs. These include septal defects, valve abnormalities, abnormalities of flow between the heart chambers and the exits (outflow tract obstruction), and heart muscle disorders.
A heart murmur is an exam finding, not a disease. Your doctor and pediatric cardiologist can determine if the murmur is innocent (which means your child is perfectly healthy) or if there is a specific heart problem. If there is a problem, a pediatric cardiologist will know how to best take care of it.
Reviewed by: Steven B. Ritz, MD
Date reviewed: May 2013
|National Heart, Lung, and Blood Institute (NHLBI) The NHLBI provides the public with educational resources relating to the treatment of heart, blood vessel, lung, and blood diseases as well as sleep disorders.|
|Congenital Heart Information Network The Congenital Heart Information Network's goal is to provide information and resources to families of children with congenital and acquired heart disease, adults with congenital heart defects, and the professionals who work with them.|
|American Heart Association This group is dedicated to providing education and information on fighting heart disease and stroke. Contact the American Heart Association at: American Heart Association|
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Dallas, TX 75231
|National Institutes of Health (NIH) NIH is an Agency under the U.S. Department of Health and Human Services, and offers health information and scientific resources.|
|March of Dimes The March of Dimes seeks to prevent birth defects, infant mortality, low birthweight, and lack of prenatal care.|
|Ventricular Septal Defect Ventricular septal defect, or VSD, is a heart condition that a few teens can have. Find out what it is, how it happens, and what doctors do to correct it.|
|Ventricular Septal Defect Ventricular septal defect (VSD) - also known as a "hole in the heart" - is a congenital heart defect. Fortunately, most VSDs are diagnosed and treated successfully.|
|If Your Child Has a Heart Defect Congenital heart defects are relatively common, affecting almost 1 in every 100 newborns in the United States.|
|Heart Murmurs Everyone's heart makes sounds, but some people have hearts that make more noise than others. Usually, however, these heart murmurs don't mean anything is wrong. Find out more about these mysterious murmurs.|
|The Heart Your heart beats and sends oxygen throughout your entire body. Find out how it works and how heart problems can be fixed.|
|Heart Disease Heart disease, also called cardiovascular disease, mainly affects older people. Find out more in this article for kids.|
|Atrial Septal Defect Atrial septal defect (ASD) - also known as a "hole in the heart" - is a type of congenital heart disease. Fortunately, most ASDs are diagnosed and treated successfully.|
|Atrial Septal Defect Atrial septal defect, or ASD, is a heart condition that teens can have. In most cases, ASDs are diagnosed and treated successfully with few or no complications.|
|Atrial Septal Defect An atrial septal defect is an opening in the wall between two parts of the heart that lets oxygen-rich blood from one side mix with oxygen-poor blood on the other side. Read more about ASDs in this article for kids.|
|Congenital Heart Defects Congenital heart defects involve abnormal or incomplete development of the heart. Learn about the different types of congenital heart defects.|
|Mitral Valve Prolapse Mitral valve prolapse (MVP) is a very common heart condition, but it isn't a critical heart problem or a sign of other serious medical conditions.|
|ECG (Electrocardiogram) Is your child scheduled to have an ECG? Find out how this test is performed and when you can expect the results.|
|Heart and Circulatory System The heart and circulatory system are our body's lifeline, delivering blood to the body's tissues. Brush up on your ticker with this body basics article.|
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