Heart Murmur

If your child has any of the following symptoms, it's important to tell your Paediatrician or Family Physician who then will make a full medical evaluation, and decide whether a referral to a Paediatric Cardiologist is required.

Infants

• Getting out of breath with feeds.
• Getting sweaty (especially cold sweats over forehead) with feeds.
• Turning blue inside the mouth (gums/tongue) and over extremities.
• Passing out/ falls unconscious.

Toddlers/children

• Unable to keep up physically with other children of same age.
• Getting out of breath with activity sooner than other children of same age.
• Getting sweaty with activity sooner than other children of same age.
• Turning blue around the gums/tongue/lips and fingers.
• Passing out/ falls unconscious.

Older children/teenagers

• Unable to keep up physically with other children of same age.
• Getting out of breath with activity sooner than other children of same age.
• Getting sweaty with exercise sooner than other children of same age.
• Turning blue around the gums/tongue/lips and fingers.
• Chest pain with exercise.
• Passing out/ falls unconscious.
• Palpitations — heart skipping a beat or beating abnormally faster.
• Dizziness with exercise.

The heart is a muscular organ with four chambers. It pumps blood out to the lungs to pick up oxygen, and out through the body to deliver oxygen. Four valves control the flow of blood through the chambers of the heart and out of the heart.

The heartbeat sounds are the sounds of the valves closing. A heart murmur is an extra sound heard when a doctor listens with a stethoscope. This extra sound is created by turbulent blood flow.

A heart murmur caused by turbulent blood flow can be either normal or abnormal. In normal heart murmurs, the flow can be heard pumping through the heart normally. This normal blood flow is called an innocent or functional murmur. More than 66 percent of all children, and approximately 75 percent of all newborns, have normal heart murmurs.

Abnormal blood flow suggests a structural heart problem or defect, which requires further evaluation.

Normal heart murmurs are usually louder when the child has a cold or fever, and typically disappear by adolescence (though not always). However, normal heart murmurs are still associated with a structurally normal heart; they do not cause any exercise restrictions or precautions, do not require antibiotics before a dental-cleaning, and do not require further cardiology evaluation.

Doctors can evaluate many characteristics of the murmur to determine if it is normal or abnormal, including:

• If it is loud or soft.
• If it is high- or low-pitched.
• Where on the chest or back it can be heard.
• If there are differences in the sound based on your child’s position.
• When the murmur occurs relative to the first and second heart sounds.

If your child’s primary doctor thinks that the murmur is normal or innocent, he or she will note the murmur on the patient file and listen again at later check-ups for changes. If you switch doctors, make sure to tell the new doctor about the innocent murmur. If your child doctor feels comfortable that the murmur is normal, there is no need for further cardiology evaluation.

Sometimes the doctor will be concerned that the murmur is not normal. In these cases, you may be referred to a Paediatric Cardiologist. It is very important to see the Paediatric Cardiologist if your child’s doctor tells you to do so.

A Paediatric Cardiologist will perform a full evaluation of your child’s health, including getting a history and performing an examination, as well as possibly ordering heart tests such as:

• Electrocardiogram: a record of the electrical activity of the heart
• Echocardiogram (also called “echo” or cardiac ultrasound): sound waves create an image of the heart
• A chest X-ray

Sometimes, abnormal murmurs don’t show up right away, and develop later. Also, there are some heart abnormalities that don’t even have murmurs.