My 6-year-old has a heart murmur. It showed up, went away, and came back, so Dr. Ben recommended we take our kid to a cardiologist to make sure that it’s nothing, which it appears to be. Along the way I was surprised to learn that 50-90% of kids will have a heart murmur at some point between birth and age 18.
A heart murmur isn’t a disease: the murmur means blood is moving through the heart especially noisily. This can be caused by a number of things, most of them innocent.
If they are so common, why do they feel like such a big deal? I asked Dr. Ben a few questions:
How much should parents freak out when they hear their kid has a heart murmur?
I say heart murmurs are like a freckle. 99% of freckles that we see on exam we don’t think need to have anything done about them. 1% of them you see a dermatologist, and even then with 99% of them, it’s not anything.
If they’re so common, how do you know which ones need to be checked out?
The intensity is one reason: sometimes you put on your stethoscope, and you hear it clear as day, or sometimes it sounds harsh, with a grating sound. A heart murmur in someone who is feeling out of breath or who has chest discomfort is a more significant detail. And when there is a family history of heart attacks or stroke, hypertrophic cardiomyopathy (disease of the heart muscle), we need to refer.
Why do heart murmurs come and go?
One reason is the size and orientation of the heart—much like a lot of different parts of the body, as children stretch out vertically, the heart organ takes on a new orientation.
The other thing that can change is a child's body composition. Skinny kids like your son have a very short distance for the noise to be transmitted from the inside to outside. As your son gets to be a bigger guy and has large pectoral muscles or as girls develop breast tissue, there’s more distance for any noise to be transmitted.
Another common reason I see them come and go is when I see a child who’s sick. Faster heart rates can lead to more turbulent blood flow. It’s very common for kids to have a heart murmur when they have a fever.
Why was my kid referred to the cardiologist?
We heard his a few years in a row, and it changed in intensity a little bit, which may have been a factor with a skinny kid with a thin chest wall.
What's an example of something more serious that a heart murmur might reveal?
I had one patient, a child who was adopted, who had a newborn screen that was normal, and all of the documentation I obtained said there was no heart murmur. When I saw the baby at a month old, the murmur had a pretty noticeable 3 out of 6 intensity. The baby had some significant stenosis, narrowing of the pulmonary artery, and is now being followed by a cardiologist. Children with that will eventually need to get that heart valve opened or replaced.
My son's cardiology visit was uneventful. The doctor recommended that we come back in a year or two to double check. How essential is this follow-up?
He ended up not needing that cardiologist per se, but he needed the evaluation based on what his exam had taught me. Over a pediatric lifetime you want to get this closed up because if you have cardiomyopathy, theoretically, if you do something like scuba diving and he has a blood clot that it gets thrown into the other side of the body, and he could have a stroke.
There are countless patients I just followed their heart murmurs until they went away. They’re really common. I have 4 or 5 patients a year that end up having a murmur that is something other than an innocent murmur.
If it’s so common, why do parents freak out about it so much?
Because it’s the heart. Parents have a hard time compartmentalizing memorable things that might have happened to someone in the family, like a heart attack. My usual explanation is just that this is something I want to monitor, and if you can’t sleep tonight, go see a cardiologist just for peace of mind. Of course that can be more difficult depending on the insurance, whether you can choose any doctor. But sending a child to a cardiologist to rule out the justifications for why a heart murmur is taking place is something that doctors do all the time.