Heart Murmur in Kids: Types, Causes, Symptoms and Treatment
A heart murmur in kids is an extra or unusual sound heard during a heartbeat. It is often described as a whooshing or swishing sound caused by blood flowing through the heart.
Heart murmurs are common in children, and most are harmless. However, some may indicate an underlying heart condition that requires medical attention.
Parents may become concerned when a doctor detects a heart murmur during a routine check-up. The important thing to understand is that not every heart murmur means a child has heart disease.
Understanding the types, causes, symptoms and treatment of heart murmurs can help parents recognise when further examination is necessary.
What Is a Heart Murmur in Kids?
A heart murmur is an additional sound produced when blood flows through the heart or nearby blood vessels. Normally, the heart makes two sounds, commonly described as "lub-dub", as its valves close during each heartbeat.
When blood flow creates vibrations, doctors may hear an extra sound using a stethoscope.
A heart murmur can be present at birth or develop later during childhood. Some children have murmurs without experiencing any health problems, while others may have a structural heart condition.
Doctors examine the sound, timing and intensity of the murmur to determine whether further testing is necessary.
Types of Heart Murmurs in Kids
Heart murmurs in children are mainly classified into two categories: innocent heart murmurs and abnormal heart murmurs.
1. Innocent Heart Murmurs
An innocent heart murmur is a harmless sound caused by normal blood flow through a healthy heart.
These murmurs are common among infants, school-age children and teenagers. They may become more noticeable during fever, physical activity or excitement because the heart pumps blood faster.
Common characteristics of innocent murmurs include:
Usually soft or gentle heart sounds
No related breathing or feeding problems
Normal growth and physical development
No underlying structural heart abnormality
No need for specific cardiac treatment
Many innocent murmurs disappear as children grow older. Others may remain without affecting their health.
2. Abnormal Heart Murmurs
An abnormal heart murmur, also called a pathological murmur, may indicate a problem with the heart's structure or function.
These murmurs can develop because of congenital heart defects, narrowed heart valves or other conditions that affect blood circulation.
Unlike innocent murmurs, abnormal murmurs require medical evaluation to identify their cause.
Treatment depends on the underlying condition, its severity and the child's symptoms.
Other Types Based on Heartbeat Timing
Doctors also classify murmurs according to when they occur during the heartbeat.
Systolic murmur: Occurs when the heart contracts and pumps blood.
Diastolic murmur: Occurs when the heart relaxes between beats.
Continuous murmur: Can be heard during both contraction and relaxation.
The timing helps doctors identify possible heart conditions. However, timing alone cannot confirm the diagnosis.
Common Causes of Abnormal Heart Murmurs in Kids
Several conditions can cause an abnormal heart murmur in children. Some are present from birth, while others develop later.
1. Congenital Heart Defects
Congenital heart defects are structural abnormalities that develop before birth.
Examples include:
Ventricular Septal Defect (VSD): A hole between the heart's two lower chambers that allows blood to flow between them.
Atrial Septal Defect (ASD): An opening between the heart's upper chambers that may increase blood flow to the lungs.
Patent Ductus Arteriosus (PDA): A blood vessel that normally closes after birth remains open, allowing abnormal blood flow.
Coarctation of the Aorta: A narrowing of the main artery that carries blood from the heart to the body.
These conditions vary in severity. Some need only monitoring, while others require treatment.
2. Heart Valve Problems
Heart valves control the direction of blood flow. If a valve becomes narrow or does not close properly, blood may flow abnormally and create a murmur.
For example, pulmonary valve stenosis makes it harder for blood to move from the heart towards the lungs.
3. Rheumatic Heart Disease
Rheumatic heart disease can develop following rheumatic fever, an inflammatory illness associated with an untreated or inadequately treated group A streptococcal infection.
It may damage heart valves and cause abnormal blood flow.
4. Heart Muscle Conditions
Certain diseases affecting the heart muscle, such as hypertrophic cardiomyopathy, can change blood flow and produce a murmur.
Other factors, including fever, anaemia and an overactive thyroid, can increase blood flow and make a murmur more noticeable. However, these factors do not necessarily indicate structural heart disease.
Symptoms of Heart Murmur in Kids
Many children with innocent heart murmurs show no symptoms. The sound is often detected during a routine medical examination.
However, when a heart murmur is associated with an underlying heart condition, certain warning signs may appear.
Common Symptoms in Older Children
Shortness of breath during physical activities
Unusual tiredness or reduced energy
Difficulty keeping up with other children during exercise
Chest discomfort, particularly during exertion
Dizziness or fainting episodes
Rapid heartbeat or noticeable palpitations
Symptoms in Babies and Infants
Heart problems can sometimes be more difficult to identify in newborns and young infants.
Parents should watch for:
Difficulty feeding or becoming tired during feeds
Excessive sweating while feeding
Poor weight gain
Fast or difficult breathing
Blue or grey colouring around the lips or skin
Important: Severe breathing difficulty, blue or grey skin, collapse or loss of consciousness requires immediate emergency medical attention.
Not every symptom is caused by a heart condition, but persistent or concerning signs should be evaluated by a doctor.
How Is a Heart Murmur Diagnosed in Children?
Doctors diagnose a heart murmur by examining the child, reviewing medical history and assessing the heart sounds.
A pediatric cardiologist may recommend additional investigations when an abnormal murmur is suspected.
1. Physical Examination
The doctor listens to the heart using a stethoscope and checks the murmur's loudness, location, timing and sound.
The child's breathing, pulse, oxygen levels and physical development may also be assessed.
2. Echocardiography (Echo Test)
An echocardiogram uses ultrasound waves to create images of the heart.
It helps doctors examine the chambers, valves, blood flow and structural abnormalities.
This is an important investigation when congenital heart disease is suspected.
3. Electrocardiogram (ECG)
An ECG records the heart's electrical activity.
It can help identify abnormal heart rhythms and certain signs of strain or enlargement.
4. Other Investigations
Depending on the child's condition, doctors may recommend pulse oximetry, chest X-rays or specialised cardiac tests.
Not every child with a murmur needs these investigations. Many innocent murmurs can be identified through a clinical examination.
Treatment for Heart Murmur in Kids
Heart murmur treatment depends on its underlying cause rather than the sound itself.
Treatment for Innocent Heart Murmurs
Innocent heart murmurs do not require medication, surgery or special treatment.
Children can generally participate in school activities, sports and everyday routines without restrictions.
Treatment for Abnormal Heart Murmurs
If a murmur is caused by a heart condition, treatment may include:
1. Regular Monitoring
Small defects or mild valve abnormalities may only require periodic examinations and echocardiograms.
2. Medication
Doctors may prescribe medicines to manage symptoms or complications associated with certain heart conditions. Medication does not directly eliminate every murmur or repair every structural defect.
3. Cardiac Catheter-Based Procedures
Some heart defects can be treated through minimally invasive procedures using thin tubes called catheters.
4. Heart Surgery
Children with significant structural heart defects may require surgery to repair the affected areas.
The treatment plan is determined by the child's diagnosis, age, symptoms and overall health.
When Should Parents Consult a Pediatric Cardiologist?
Parents should seek a pediatric cardiology consultation if a doctor suspects an abnormal murmur or their child has symptoms suggesting a heart problem.
Early evaluation can help identify structural abnormalities and determine whether treatment or monitoring is required.
Dr Amitoz Baidwan provides pediatric cardiology consultations in Mohali, including assessment of heart murmurs, congenital heart conditions and pediatric echocardiography.
Protect Your Child's Heart Health with Early Evaluation
A heart murmur in kids is not always a sign of a serious condition. Most innocent murmurs are harmless, but abnormal murmurs may indicate heart problems requiring further assessment.
If your child's doctor has detected a heart murmur or you have noticed concerning symptoms, timely evaluation can help determine the appropriate next steps.
Book a consultation with Dr Amitoz Baidwan to discuss your child's heart health, diagnostic tests and available treatment options.
Frequently Asked Questions
1. When to worry about a heart murmur?
A heart murmur may need further investigation if a child experiences breathlessness, poor growth, feeding difficulties, unusual tiredness or fainting. A loud or unusual murmur may also require specialist evaluation, even without symptoms. Emergency care is necessary for severe breathing problems, blue or grey skin or collapse.
2. Can I live a normal life with a heart murmur?
Yes. Children with innocent heart murmurs can live normal, healthy and active lives without treatment or physical restrictions. Children with abnormal murmurs may also lead active lives, depending on the underlying condition and the treatment required. A pediatric cardiologist can advise on appropriate activities.
3. How do you treat a heart murmur?
Treatment depends on the cause. Innocent murmurs do not need treatment. If the murmur is associated with congenital heart disease or a valve problem, doctors may recommend regular monitoring, medication, catheter-based procedures or surgery, depending on the severity.
4. What can cause a heart murmur?
A heart murmur can result from normal blood flow, congenital heart defects, heart valve abnormalities or heart muscle conditions. Fever, anaemia and an overactive thyroid can also increase blood flow and produce a murmur. A medical examination helps identify the cause.
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