From the Guidelines
If you notice any worrisome signs of a new murmur in your child, such as difficulty breathing, rapid breathing, or excessive sweating, seek immediate medical attention. When educating a mother about the signs of a potentially serious heart murmur, it's essential to emphasize the importance of monitoring for certain symptoms. These include bluish discoloration of the lips or skin (cyanosis), poor feeding or difficulty eating, unusual fatigue or tiredness, fainting episodes, chest pain, or swelling in the legs, abdomen, or around the eyes 1. Additionally, poor weight gain or growth, and any significant change in the child's energy level or behavior, should be reported to the healthcare provider promptly.
Some key characteristics of heart murmurs that may indicate a more serious condition include their timing in the cardiac cycle, configuration, location and radiation, pitch, intensity, and duration 1. Diastolic murmurs, for example, virtually always represent pathological conditions and require further cardiac evaluation. The configuration of a murmur may be crescendo, decrescendo, crescendo-decrescendo (diamond-shaped), or plateau, and the precise times of onset and cessation of a murmur associated with cardiac pathology depend on the period of time in the cardiac cycle in which a physiologically important pressure difference between 2 chambers occurs 1.
It's crucial for mothers to attend all follow-up appointments with their child's healthcare provider and to monitor their child's growth and development closely. If any concerning symptoms are noticed, it's vital to contact the child's doctor immediately or seek emergency care, as early detection and treatment of heart problems can prevent complications and lead to better outcomes for the child.
From the Research
Worrisome Signs of a New Murmur
- A holosystolic or diastolic murmur, as these types of murmurs are more likely to be associated with underlying heart disease 2
- A grade 3 or higher murmur, as louder murmurs are more likely to be pathologic 2
- A harsh quality to the murmur, as this can indicate turbulence of blood flow 2
- An abnormal S2, as this can indicate problems with the heart valves 2
- Maximal murmur intensity at the upper left sternal border, as this can indicate issues with the aortic valve 2
- A systolic click, as this can indicate problems with the mitral valve 2
- Increased intensity of the murmur when the patient stands, as this can indicate issues with blood flow 2
Education for a Mother
- It is common for healthy children to have a murmur, but it is essential to have it evaluated by a pediatrician to determine if it is innocent or pathologic 3
- The presence of a murmur can indicate conditions ranging from no discernable pathology to acquired or congenital heart disease 4
- A pediatric cardiologist should be consulted if a murmur is detected in a newborn, as neonatal murmurs have higher rates of pathology than in older children 4
- Pulse oximetry screening should be performed on all infants to detect underlying critical congenital heart disease 4
- In older children, most murmurs are innocent and can be followed with serial examinations if there are no findings of concern 4
Red Flags for Pathologic Murmurs
- Diastolic murmurs, as these are more likely to be associated with underlying heart disease 4
- Loud or harsh-sounding murmurs, as these can indicate turbulence of blood flow 4
- Holosystolic murmurs, as these can indicate problems with the heart valves 4
- Murmurs that radiate to the back or neck, as these can indicate issues with the aortic valve 4
- Signs or symptoms of cardiac disease, such as shortness of breath, fatigue, or chest pain 4