Heart murmur

My son has a murmur. Are all murmurs bad or pathological? What is a puff?

Heart murmurs are sound waves with frequencies between 20 and 2,000 hertz (Hz), or cycles per second, which are caused by turbulence in the blood flow in the heart and great vessels.

Auscultation of a heart murmur is a common occurrence on physical examination in children and adolescents. Most of them are functional, innocent or normal, that is, they appear in the absence of structural heart disease. However, the presence of a heart murmur may be a sign of congenital heart disease, the early diagnosis of which is important.

The prevalence of congenital heart defects is 6 per 1,000 live births and it is estimated that in our country, 18-20,000 children are born with heart disease per year. The prevalence of functional murmurs in childhood is over 50%, reaching in some studies 75-80%.

The differential diagnosis between a functional and a pathological murmur can be made based on exploration. However, cardiac auscultation in children is a difficult technique, requiring some degree of patient training and cooperation.

Informing parents that their child has a murmur involves a host of emotional and financial aspects to healthcare and is not an easy task.

When to refer a patient with a heart murmur to a pediatric cardiologist?

The doctor should refer a child to the pediatric cardiology consultation if:

• Examination or questioning suggests cardiac pathology.
• There is a family history that forces to rule out heart disease.
• The child has a syndrome or malformation that is associated with congenital heart disease.
• There are 3 or more symptoms: chest pain, palpitations, sweating of hands and feet, dizziness, headache, blurred vision, dyspnea (shortness of breath), tiredness; cyanosis (bluish discoloration of the skin).
• It cannot be defined with certainty that what is heard is a functional murmur.
• Neonates and infants with murmurs, because although the prevalence of functional murmurs is higher in this age group, a higher number of congenital heart defects are also detected, sometimes still asymptomatic.

Although patent foramen ovale is not a heart disease, it can sometimes (aneurysmically) behave like a small defect and require medical surveillance; In the case that is associated with a significant short circuit or cerebral vascular accidents, it must be closed after evaluation by an interventional cardiologist. The ductus arteriosus is a normal structure in the fetal stage, which, if it persists, will require medical, pharmacological, interventional (closure by catheterization) or surgical treatment.

Once the diagnosis of a functional or pathological murmur has been made, the pediatric cardiologist will adequately inform the parents and make the pertinent recommendations, as appropriate.