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Heart Murmurs

by Sue Hubbard, M.D.

I received an email from Brinley who was worried that her 1 year old had recently been found to have an “innocent heart murmur” and she wondered what this meant.  Did she need to see a specialist?

A heart murmur is simply an extra sound the doctor hears when listening to your child’s heart with their stethoscope.  A murmur is caused by the flow of blood through the heart or the major blood vessels around the heart. In the case of an “innocent” heart murmur the flow is through a completely normal heart and is solely due to turbulence but there is nothing else wrong with a child’s heart therefore, the term ”innocent murmur”.  These murmurs may also be called functional, benign, or a Still’s murmur.

Innocent murmurs are very common and may be heard at different times in a child’s life.  Some cardiologist’s quote that somewhere between 50 – 90% of children will have an “innocent murmur” at some time during their childhood. None of these children have any underlying cardiac pathology.

It is quite common to hear an “innocent murmur” in a child due to the fact that their heart is close to their chest wall, especially in thin children.  It is also not uncommon for the doctor to hear the murmur on one exam and maybe not on the next, as it depends on the position the child is in when they are examined as well as other factors.  Fever is one of the most common reasons that a child is found to have an innocent murmur as their heart rate is typically higher and the blood flow is more dynamic.

The quality of the murmur is what lets the doctor know that it is an “innocent murmur”.  Murmurs are graded on intensity from a grade 1 to grade 6 (the loudest).  Most benign murmurs are a grade 1 or grade 2, and they have a musical or vibratory quality.

If you have concerns about an innocent murmur a pediatric cardiologist may be consulted. In most cases they will not only listen to your child’s heart, but also do an EKG and an echocardiogram to ensure that your child’s heart is structurally normal. Don’t worry. These murmurs usually go away as your child reaches adolescence.

That’s your daily dose for today.  We’ll chat again tomorrow.

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