When you take your little one or newborn baby to the doctor, the first thing a doctor will do is place a stethoscope on the chest and listen to the heart. You will hear the normal "lub-dub" heartbeat sounds that come when the heart valves close. But sometimes, in addition to this sound, you will hear an additional sound, like a small "s...s...", like a sound like air passing through. The doctor will call this a "heart murmur," or a murmur in the heart. It is normal for any mother or father to feel scared when they hear these words. But are all these murmurs really dangerous? Let's talk about this in detail, simply.
What is a 'Heart Murmur'?
Imagine that our heart is a wonderful pump with four chambers. This is what pumps blood throughout the body. It has four gates (valves) that work like a faucet to keep this blood flowing in only one direction. When these gates open and close at the right time, we hear the normal "lub-dub" sound of the heart.
So how does this extra sound called 'murmur' come about? Simply put, this sound is made when there is some obstruction or abnormal flow of blood through the heart. It's like when water flows freely through a water pipe, there is no sound, but if the pipe is clogged or has a small hole, there is a "s...s..." sound.
There may be several reasons for this:
- Rapid blood flow due to narrowing of a heart valve.
- A valve that does not close properly and blood leaks backward (leaky valve).
- A small hole between the chambers of the heart that is not normally present.
- Abnormal connections between the main blood vessels leaving the heart.
- Abnormal thickening of the heart walls.
The important thing is that not all murmurs are a sign of illness. In fact, about two-thirds of healthy children and about three-quarters of newborns will hear an innocent murmur at some point in their lives.
Types of murmurs that are harmless (Innocent) and should be considered (Pathological)
When your child hears a heart murmur, the doctor will try to determine whether it is an innocent murmur or a pathological murmur caused by a heart condition. See the table below to understand this distinction.
| Characteristic | Innocent Murmur | Murmurs to be concerned about (Pathological Murmur) |
|---|---|---|
| The sound you hear | A soft, short sound. Like a breeze. | A harsh, harsh, continuous sound. |
| Change with body position | The intensity of the sound changes when the child sits or stands up. Sometimes it becomes inaudible. | The sound continues to be heard even if the body position is changed. |
| Other symptoms | There are no other symptoms. The child is playing well, eating and drinking, and gaining weight. | Other symptoms may include difficulty breathing, blue lips and fingers, difficulty breastfeeding, and failure to gain weight. |
| Final result | This sound disappears as the child grows. No treatment is needed. | A sign of an underlying heart condition. Further testing and treatment are needed. |
What are the concerns of the doctor?
When a doctor hears a murmur, they are particularly concerned about these things:
- Loudness: How loud is the murmur? (These are rated from 1 to 6).
- Pitch of the sound: Is it high pitched or low pitched?
- Location: Where in the chest is it heard most?
- Radiation: Does this sound radiate to other parts of the chest or back?
- Timing: When is this sound heard between two normal heartbeats? When the heart contracts (`Systole`) or relaxes (`Diastole`)?
Only after carefully analyzing this information will the doctor decide whether this is harmless or whether the patient should be referred to a pediatric cardiologist.
Heart Murmurs in Newborn Babies
It is very common for newborns to hear a heart murmur. Sometimes, these sounds can occur during the process of closing some of the heart's valves at birth. So, even if the doctor says there is a murmur during the first checkup, don't be alarmed. It usually disappears during the next checkup, which is done in a few weeks.
However, if the murmur persists or if the doctor has even the slightest suspicion about it, he will definitely refer you for further tests.
Warning signs to watch out for
If you know your child has a murmur, keep an eye out for the following symptoms. If you notice any of these, contact your doctor immediately.
- Shortness of breath: If you feel like you're having trouble breathing, especially when breastfeeding or doing light activity.
- If you have frequent chest infections.
- Difficulty drinking or eating milk: Feeling tired, sweating, and stopping drinking milk after drinking a little milk.
- Growth failure: If weight gain is not appropriate for age.
- Blue discoloration of the lips, tongue, or skin (Cyanosis): If this is evident when crying or breastfeeding, it may be a sign of insufficient oxygen in the blood flowing from the heart to the body.
Symptoms like these mean that the murmur may be related to some kind of heart condition.
Treatment and next steps
An innocent murmur does not require any treatment. It does not require medication, surgery, or restrictions on the child's activities. It will go away on its own as the child grows older. This sound may be louder during times of fever or stress.
However, if the murmur is pathological, the cause needs to be determined. The doctor may recommend some tests, such as:
- Echocardiography (Echo): This is like an ultrasound scan of the heart. It can clearly see the function of the heart's chambers, valves, walls, and whether there are any holes or leaks in the valves.
- Chest X-ray: This helps to get an idea of the size and shape of the heart and the blood vessels leading to the lungs.
Treatment depends on the underlying heart condition causing the murmur. Some congenital heart diseases resolve on their own over time. Others may require medication or surgery.
Another important thing to note is that some heart conditions put your child at higher risk of developing a heart infection (infective endocarditis). In such cases, your doctor may recommend antibiotics to prevent infection before a tooth extraction or other surgery.
Take-Home Message
- Not all heart murmurs heard in children are dangerous. The majority are harmless.
- A murmur is not a disease, it is just a sound that can be a symptom of a disease.
- If your child has symptoms such as difficulty breathing, blue lips, difficulty eating/drinking milk, or failure to gain weight, seek medical advice immediately.
- Follow the doctor's instructions exactly. If he asks you to come back for a check-up, be sure to go on the scheduled date.
- It is your right to openly discuss any concerns or fears you have with your doctor.
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