Heart Murmurs in Children

Heart murmurs in children are one of the four most common reasons for new-patient referrals to the Children's Healthcare of Atlanta Heart Center. Our doctors have found that there is a lot of misinformation about what a heart murmur is and what it means for a child who has one. Here, Robert Campbell, MD, Pediatric Cardiologist, explains heart murmurs in children and what they may mean for patients and families.

What is a heart murmur?

In the simplest terms, a heart murmur is the noise of turbulent blood flow. “Think about a mountain stream,” Dr. Campbell says. “Smooth water flow in the stream makes close to no noise, but the same water downstream over the rocks and rapids makes a lot of noise. That's because it's a turbulent area for water.” Pediatricians can hear these murmurs through the stethoscope while listening to your child's heartbeat.

What is an innocent heart murmur?

Even normal blood flow has turbulence. When this occurs, it’s referred to as an innocent murmur. “Innocent murmurs are simply the noises made as blood flows through the heart, over the valves and through the blood vessels. These heart murmurs in children are common, and they will often disappear on their own as children get older,” says Dr. Campbell.

If your child is diagnosed with an innocent heart murmur, no further testing is needed. These murmurs may come and go over time and can vary in loudness depending on a patient’s position during an exam. Symptoms are not expected, and activity restrictions are not required. Generally, after a pediatric cardiology evaluation and clearance, patients with innocent murmurs will be followed long term by their pediatric care providers.

What is a serious heart murmur, and what does it mean for my child?

If a pediatric cardiologist confirms through testing that your child’s heart murmur is serious, then it could be caused by a heart condition.

“Not all heart murmurs are the same,” explains Dr. Campbell. “Some heart murmurs may be the first sign of underlying heart disease. Others could be caused by more minor heart conditions. Still other heart murmurs may be caused by a heart defect.”

What does a heart murmur mean?

Does a heart murmur mean my child has a heart problem?

A heart murmur and heart disease are not the same thing. A heart murmur is the noise of turbulent blood flow, and all blood flow is turbulent inside normal and abnormal hearts. In some thin-chested patients, the noise of normal turbulent blood flow may be heard; these are called innocent heart murmurs, and there are several different types. On the other hand, some heart murmurs may be the first sign of underlying heart disease, such as a hole in the heart, blocked valve, leaky valve, heart muscle problem or blood vessel problem.

Do heart murmurs require further testing?

If your child's pediatrician hears a heart murmur, he or she should be able to detect the difference between an innocent and serious heart murmur. “If any heart murmur is detected, your pediatrician should get a full medical history of your child and may want to run tests to be sure the heart murmur is, in fact, innocent,” says Dr. Campbell. “Once tests confirm the heart murmur is innocent, there's usually no need for a follow-up appointment.”

Evaluation of a heart murmur may include a:

• Detailed family history
• Patient history
• Physical exam
• Resting electrocardiogram (ECG)
• Chest X-ray or an echocardiography (heart ultrasound)

If there is any concern that your child's heart murmur is serious, your pediatrician will refer you to a pediatric cardiologist.

My child's pediatrician heard a heart murmur. Now what?

If your child has a heart condition that requires further pediatric testing, it's critical that your child see a pediatric cardiologist, who has special training and equipment to care for small and growing hearts.