© 2013 Roy Benaroch, MD
Here’s a question: “My daughter was found to have a heart murmur at a well check. Is this something I need to worry about?”
A murmur just means a noise—the noise of blood swishing through the heart and blood vessels of the chest. Because children have thin chest walls and very little fat under their skin, murmurs are heard very commonly in kids. About 50% of kids will have a murmur heard at least once during their childhood.
Almost all of these murmurs heard in healthy children mean nothing. Their hearts are fine. In adults, though, murmurs often mean there is some kind of problem with the heart. This is a good example of how different kids are from adults.
Evaluating a newly-heard murmur starts with asking about the history. Is there anything going on that possibly suggests a heart problem? For instance, has there been fainting or chest pain during exercise? Is there a family history of heart problems in young people? Murmurs are always more concerning in a child whose history is suspicious for possible heart disease.
The murmur itself needs to be listened to carefully, often while moving the child into different positions. Based on how it sounds, a pediatrician can tell how likely that particular noise is to indicate an actual heart problem. Since most murmurs in kids are normal, we don’t usually refer all of them to cardiologists or for testing (if we did, there wouldn’t be nearly enough cardiologists or EKG machines.) If I listen to a murmur and I’m confident it’s normal, I’ll tell that to the parents and I won’t refer. If I listen to a murmur and I think it might be an abnormal sound, or if I’m worried based on the history or other findings, I’ll refer the child for further evaluation.
Murmurs (especially normal murmurs that don’t mean anything) come and go. Doctors can hear them better when the heart beats stronger (for example, during a fever or when a child is excited). Murmurs may be missed if a child is upset or yelling during an exam. Though some are present from birth, it’s not unusual for a murmur to be first heard in a child at any age.
So: though most murmurs in children are normal, they do need to be evaluated carefully by considering the history and complete physical exam. Many can be easily distinguished at the pediatrician’s office as normal, without further testing. Others are kind of borderline, and may turn out to be normal—but need additional confirmation to prove that. If as a parent you’re uncomfortable without confirmation that a murmur is normal, speak up—don’t just worry silently. I never mind doing a referral for reassurance for myself, OR a parent.