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Heart Disease in Children: Heart Murmurs
Craig Barstow1, Ryan Flanagan2
1FirstHealth of the Carolinas, Pinehurst, NC.
Insights
Pediatric heart murmurs are common, but most are benign. Pathologic murmurs, often linked to structural defects or acquired conditions, require evaluation by a pediatric cardiologist.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Medicine
- Diagnostic Imaging
Background:
- Heart murmurs are frequently detected in children, necessitating careful evaluation.
- While 1-5% of infants have murmurs, up to 50% may stem from structural defects, primarily congenital heart disease.
- Most congenital heart disease in asymptomatic children is minor and resolves spontaneously.
Purpose of the Study:
- To differentiate between benign and pathologic heart murmurs in pediatric populations.
- To highlight the prevalence and causes of heart murmurs in infants and children.
- To emphasize the role of pediatric cardiologists and echocardiography in murmur evaluation.
Main Methods:
- Clinical assessment of murmur characteristics to distinguish benign from pathologic types.
- Review of diagnostic criteria for congenital heart disease and acquired valvular conditions.
- Echocardiography as the primary imaging modality for murmur evaluation.
Main Results:
- Less than 30% of referred pediatric murmurs are ultimately determined to be pathologic.
- Congenital heart disease is the most common diagnosis in infants with murmurs, but often minor.
- In older children, cardiomyopathies and acquired valvular disease are significant causes of pathologic murmurs.
Conclusions:
- Most childhood heart murmurs are benign and do not require intervention.
- Referral to a pediatric cardiologist is crucial for murmurs with associated cardiac signs or symptoms.
- Echocardiography is the gold standard for diagnosing the cause of pediatric heart murmurs.
Abstract:
Heart murmurs are common in childhood. Any murmur associated with cardiac signs or symptoms should be referred to a pediatric cardiologist for further evaluation. A benign murmur typically can be differentiated from a pathologic murmur based on its characteristics. Between 1% and 5% of newborns and infants will have a murmur, and up to 50% of those will be due to a structural defect. Congenital heart disease is the most common diagnosis in newborns and infants with a murmur, but a majority of congenital heart disease lesions diagnosed in asymptomatic infants and children will be minor and resolve with time. Although up to 50% of children will have a murmur at some time in their life, less than 30% of murmurs referred to pediatric cardiologists are pathologic. In older children, undiagnosed congenital heart disease is much less common than cardiomyopathies and acquired valvular disease, which are important causes of pathologic murmurs. Echocardiography is the preferred imaging modality for evaluating murmurs.
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