Murmur is the hearing of the blowing-like sounds caused by the reflection of the turbulence of the blood flow in the heart and vessels on the chest wall with a listening device (stethoscope). Heart murmurs, which are among the common findings in cardiac examination, according to their various characteristics; These are differentiated as innocent murmurs, functional murmurs and pathological murmurs.
Murmur detection is important in children’s examinations.
Heart murmurs heard in the examinations of children may be a sign of an underlying heart disease; the majority of them are innocent murmurs and some of them are functional murmurs. Innocent murmurs can be heard in 50-85 percent of healthy children. Although innocent murmurs are sounds originating from normal healthy heart, pathological murmurs are due to heart disease. In some cases such as anemia, functional murmurs can be heard.
Murmur can occur at any age
Although heart murmurs are seen at all ages, innocent murmurs can often be detected after 4-5 years of age. While pathological murmurs due to congenital heart diseases are heard from birth, murmurs due to acquired diseases can occur at any age. However, there are also innocent murmurs heard in the newborn and infancy.
Children often have an innocent murmur
Innocent murmurs, which most often occur at the age of 4-5, can be heard higher in fever, running and other situations that increase heart rate. Since children are usually taken to the doctor when they have fever, the murmur can be felt better during these examinations. The loudness of innocent murmurs may increase in such cases, as well as decrease or disappear over time, or continue in the same way.
Beware of pathological murmurs!
A lesser proportion of murmurs in children are pathological murmurs, that is, murmurs due to underlying heart diseases. These heart diseases can be congenital or acquired diseases in which permanent findings occur in the heart due to some diseases affecting the heart. While murmurs are heard from birth in congenital heart diseases, in acquired diseases, murmurs may appear later at any age. For example, acute rheumatic fever can cause damage to the heart valves, aortic and mitral valve diseases and murmur by affecting the heart. Acute rheumatic fever is a common condition between the ages of 5-15, while murmur also occurs after these ages. Another disease affecting the heart is Kawasaki disease. In addition, the heart is rarely affected in diseases such as juvenile rheumatoid arthritis and systemic lupus. Murmur can also be seen in these diseases in the following period.
Watch out for developmental delay and bruising that accompany the murmur!
In children with murmur, more or less signs and symptoms may occur related to the underlying cause. In some cases, the only finding may be murmur. Intra-cardiac holes and openings between great vessels constitute a significant part of congenital heart diseases. These holes are usually asymptomatic when small, but are noticed by a murmur during examination. When the heart holes are large, problems such as not being able to gain weight, feeding difficulties, respiratory and frequent respiratory infections are observed.
Bruising and breathing difficulties can be noticed in diseases such as tetralogy of Fallot and inversion of large vessels. Beyond these, many more severe complex congenital heart diseases can be seen. Symptoms such as bruising, shortness of breath, fatigue, feeding difficulties, and inability to gain weight can often occur in these heart diseases. However, it should be kept in mind that the symptoms of some important heart diseases can be very insidious and this may lead to delays in diagnosis and treatment.
Genetic and environmental factors are important
Genetic and environmental interactions play a role in the formation of congenital heart diseases. Syndromic conditions, hereditary diseases and chromosomal anomalies increase the risk. However, those with congenital heart disease in their parents or siblings have an increased risk of disease compared to those who do not. Acute rheumatic fever, which causes rheumatic valve diseases such as mitral and aortic valve diseases, is seen in those who have upper respiratory tract infection with Beta hemolytic sterephotococcus. Acute rheumatic fever, which is affected by environmental factors, is observed more in crowded and low socioeconomic level populations and recurrence is possible due to genetic predisposition.
Differential diagnosis of murmur should be made.
Murmurs heard in the hearts of children must be differentially diagnosed by a pediatric cardiology specialist. After the diagnosis, follow-up and treatment planning should be done if necessary. Otherwise, there is a risk of going through irreversible processes with the delusion of innocent murmur.
No treatment is required for innocent murmurs
Innocent murmurs do not need to be treated because they do not show signs of illness and do not affect the child’s life, physical and sports activities. Treatment and follow-up approaches for murmurs due to heart diseases vary according to the underlying cause. However, not all heart diseases that cause a murmur need treatment. For example, small holes in the heart, mild valve stenosis and insufficiency do not require treatment. However, lifelong follow-up should be performed in terms of life-long adverse symptoms and complications.
Interventional or surgical methods are used if there is a significant heart problem
Depending on the size of the hole in the heart, the amount of stenosis or leakage in the valve, some of these disorders are followed only with routine controls and some with medication. In cases of clinically important holes, strictures, insufficiencies and more important structural heart diseases, treatment should be planned with invasive or surgical methods and followed up for a lifetime.