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Navigating heart murmurs in children
Ashani Mahawattege1, Lauren Shearer2, Aaron Chambers3
1MBBS, DCH, Paediatric Cardiology Fellow, Queensland Children@s Hospital, South Brisbane, Qld.
Insights
Most childhood murmurs are harmless, but primary care physicians must identify concerning features. This guidance helps assess pediatric murmurs and detect serious cardiac conditions.
Area of Science:
- Pediatric Cardiology
- Clinical Assessment
Background:
- Childhood murmurs are common, with 99% being non-pathological.
- Cardiovascular examination is crucial in routine neonatal and child health checks.
- Innocent murmurs develop in a significant proportion of children.
Purpose of the Study:
- To provide guidance on assessing pediatric murmurs.
- To assist primary care physicians in identifying concerning murmur features.
Main Methods:
- Assessment relies on history, physical examination, and preliminary investigations.
- Identifying red flags for serious cardiac pathology is key.
- Decision-making focuses on features beyond the murmur itself.
Main Results:
- Most pediatric murmurs are innocent and do not require intervention.
- Specific red flags in history and examination can indicate serious pathology.
- Prompt referral is necessary for concerning findings.
Conclusions:
- Primary care physicians need to differentiate between innocent and pathological murmurs.
- A systematic approach incorporating red flags ensures appropriate management.
- Early detection of serious cardiac defects improves outcomes.
Background:
Murmurs are a common finding in the paediatric population, with 99% being non-pathological. Cardiovascular examination is recommended to aid the detection of serious structural cardiac defects as a routine part of neonatal and child health checks. Incidentally noted murmurs are also a common finding, with a significant proportion of children developing an innocent murmur at some stage of childhood. It is therefore important for primary care physicians to be able to appropriately identify concerning features of both screening detected and incidentally noted murmurs in children.
Objective:
The aim of this article is to provide guidance around the assessment of a child with a murmur.
Discussion:
In the assessment of murmurs, decision making around the level of concern for a pathological murmur and urgency for referral is predominantly based on features other than the murmur itself. Red flags for serious pathology might be obtained through history, examination and preliminary investigations.
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