What to Know about Heart Murmurs in Children

Heart murmurs are abnormal sounds that are heard when examining the heart with a stethoscope. There are three different types of murmurs depending on when it occurs during a heartbeat: systolic occurs during contraction, diastolic occurs during relaxation and continuous occurs throughout the heartbeat. The loudness is graded on a scale of 1 to 6, one being barely audible and six being very loud.

Sarah Perkins, MD, is a pediatric cardiologist at Loyola Medicine who discussed everything parents need to know about the condition. "Hearing that your child has a heart murmur can be scary, but it's important to understand the murmur is just an extra heart sound," said Dr. Perkins. "It may or may not mean that something is wrong."

What to expect if your child has a heart murmur

Meet pediatric cardiologist Sarah Perkins, MD.

What causes a heart murmur?

For many typical, healthy children, a heart murmur is nothing to worry about. Called innocent murmurs, these are the most common type likely caused by the sound of blood moving through a healthy heart in a normal way. These innocent murmurs can come and go throughout childhood, and children with them don't need to change their lifestyle, whether that be exercise, diet or special treatments.

"We don't know exactly what causes innocent murmurs," says Dr. Perkins. "They are most likely caused by blood pumping through the normal heart chambers and across the valves making a whooshing sound that is easier to hear through the thinner chest wall of a young child."

However, about 1 out of every 100 children will be born with a structural heart problem, or congenital heart defect, that causes heart murmurs. Children with a heart defect may show symptoms within the first few days of life or potentially not until later in childhood. A heart murmur is just one symptom that could occur, but there are others, like rapid breathing, trouble feeding and blueness in the face.

"This type is much less common and are seen in less than 1% of all children," she says. "They can be due to congenital heart disease (something they are born with) or sometimes an abnormality that developed later. If your pediatrician thinks the murmur sounds concerning, then they will refer you to a pediatric cardiologist for more evaluation."

If a heart murmur or any of these symptoms present themselves, a physician will likely order one or a variety of tests, such as a chest x-ray (a picture of the heart), an EKG (a reading of the heart's electrical activity), or echocardiogram (sound waves that show the heart's movement).

Some of the most common childhood heart defects include:

• Septal defects where there is a hole in the wall (or septum) of the top and bottom chambers of the heart.
• Valve abnormalities where certain heart valves may be too big, too thick, too small or abnormal in some other way.
• Heart muscle disorders which make the heart muscle too thick or weak.

Your child's pediatrician can help you understand whether a heart murmur is innocent or indicative of something more serious.

How are heart murmurs treated?

Innocent murmurs don't require treatment at all as many of them will go away on their own as the child grows up. However, depending on the underlying cause of the heart murmur, treatment will vary. Treatment will also depend on the symptoms, age, overall health and severity of the condition.

"The murmur is just a sound and not a problem in itself," says Dr. Perkins. "Treatment depends on the cause of the murmur. Innocent murmurs require no treatment. Some minor cardiac problems need only observation. The cardiologist may have the child come back every year or so to keep an eye on the issue."

If the heart murmur is from a heart defect, treatment can involve a variety of things, including medicine, procedures or surgery. Medications may include blood thinners, diuretics, or medications that lower heart rate and blood pressure.

If surgery is needed, you can expect different procedures depending on the condition. For example, during a heart valve repair surgery the surgeons will patch holes in the valve, replace the cords that support the valve, remove excess valve tissue and tighten the ring around the valve. The surgeries can also be done in different ways, such as an open-heart surgery, a catheter procedure, or a minimally-invasive surgery.

The way the surgery or procedure is performed depends on the specific heart condition and the severity.

What are the possible complications of heart murmurs?

Heart murmurs themselves have no complications. However, the underlying condition causing the heart murmur may cause complications. A child with a heart defect may have poor growth, heart failure or other serious problems. These can include:

• Infection of the heart's valves or inner lining
• Blood clots and stroke
• Fainting
• Sudden cardiac arrest

It's difficult to specify the exact complication without first knowing the condition behind the heart murmur. Your child's pediatrician can explain things more.

"Some abnormalities, such as small holes in the heart, often close completely on their own over time," says Dr. Perkins. "More severe heart problems require treatment including medications, minimally invasive catheter procedures or sometimes heart surgery to repair the problem."

When should I call my child's pediatrician?

Many heart defects will be caught before or after birth, allowing you time to understand the implications, treatments and future for your child. However, often this is not the case, which means parents need to understand the symptoms of heart disease to know when to call their child's pediatrician.

Symptoms can vary between child and teenager but in general, the symptoms of heart defects and disease are:

• Trouble feeding or eating
• Not gaining weight normally
• Trouble breathing
• Fainting
• Rapid breathing
• Blue face, legs or feet
• Tiredness or trouble exercising
• Chest pain

If any of these symptoms occur, call your child's pediatrician immediately as it may be indicative of an underlying condition. And, most importantly, ask questions.

"We are happy to answer your questions. Ask what the murmur sounds like, ask if it has been noted at any previous visits, ask what the doctor thinks may be causing it, anything you want," says Dr. Perkins. "Pediatric cardiologists love to draw heart diagrams for parents. So if a cardiac problem is found, ask us to draw a picture or find a picture online to explain it. A picture is worth a thousand words!"

Loyola primary and specialty care offices are conveniently located throughout Chicago’s western and southwestern suburbs. Our Pediatric department at Loyola Medicine has one of the most comprehensive and advanced teams in the nation.

To make an appointment, call 888-584-7888 or schedule an appointment online.

Sarah Perkins, MD is a pediatric cardiologist at Loyola Medicine. Dr. Perkins received her medical education from Washington University in St. Louis School of Medicine before completing her residency and earning her fellowship at McGaw Medical Center of Northwestern University.

Dr. Perkins takes great pride in helping children of all ages with heart defects, conditions or general heart health. She receives many referrals from pediatricians across the Chicagoland area to evaluate children who have heart murmurs and other abnormalities.

Book an appointment today to see Dr. Perkins or another Loyola physician by self-scheduling an in-person or virtual appointment using myLoyola.