Cardiac Workup: Necessary For All Newborns With A Murmur?

Heart murmurs in newborns are a common occurrence, often harmless, and are usually discovered during routine check-ups. They are caused by turbulent blood flow through the heart, resulting in abnormal sounds such as whooshing, rasping, or swishing. Murmurs are graded on a scale of 1 to 6 based on volume, with 1 being very faint and 6 being loud enough to hear without a stethoscope. While most murmurs are innocent and disappear as the child grows, some may indicate an underlying condition that requires monitoring or treatment. In such cases, a pediatric cardiologist will be consulted, and further tests such as an echocardiogram, electrocardiogram, or chest X-ray may be ordered. Treatment depends on the type of murmur and ranges from monitoring to surgery for severe cases.

Innocent heart murmurs are common in newborns and are typically harmless

Innocent Heart Murmurs in Newborns

Innocent heart murmurs are often caused by rapid and turbulent blood flow combined with smaller-than-normal blood vessels. As a baby grows, their blood vessels also grow, and this typically causes the murmur to disappear on its own. In some cases, innocent heart murmurs can also be caused by illness or anemia, which increases the speed of blood flow as the body works to deliver oxygen to where it's needed.

While innocent heart murmurs are usually harmless, it's important to follow up with a pediatrician or pediatric cardiologist to ensure a thorough evaluation. In rare cases, a heart murmur may indicate an underlying condition that requires monitoring or treatment.

Types of Innocent Heart Murmurs

There are four main types of innocent heart murmurs:

• Pulmonary flow murmur or peripheral pulmonary stenosis (PPS): Occurs when a baby is born with small pulmonary blood vessels. It typically goes away as the child grows but may be associated with congenital heart disease, so continued care is important.
• Supraclavicular systemic flow murmur: Thought to be caused by the fast flow of blood from the aorta into head and neck blood vessels. It is described as a low, harp-like hum and typically occurs in children aged 3 to 6 years but can also occur in infants and adults.
• Still's murmur: A common innocent murmur in childhood, characterised by a soft, systolic sound with a small area of involvement on the precordium.
• Venous hum: Another type of innocent murmur that does not always follow the typical characteristics of innocent murmurs.

Symptoms and Diagnosis

Innocent heart murmurs usually do not cause any symptoms, and children remain asymptomatic as the murmur disappears. However, in some cases, they may cause slow or delayed growth, cyanosis (bluish colour of the skin and lips), respiratory distress, or sweating during feedings. Diagnosis is typically made by a doctor using a stethoscope, and further evaluation may be done by a pediatric cardiologist.

Newborns with a heart murmur may be referred to a paediatric cardiologist for further tests

Heart murmurs in newborns are common and often harmless. However, it is important to follow up with a paediatric cardiologist if your newborn has received a heart murmur diagnosis, as they will be able to determine whether further tests are required.

Heart murmurs are extra or abnormal sounds made by turbulent blood flowing through the heart. They are graded on a scale of 1 to 6, based on how loud they are. Murmurs can be present at birth (congenital) or develop later in life (acquired). Some heart murmurs are harmless (innocent), while others may be a sign of a serious heart condition.

If your newborn has received a heart murmur diagnosis, the paediatric cardiologist will be able to determine whether the murmur is innocent or abnormal. Innocent heart murmurs are often caused by quick and rapid blood flow combined with smaller-than-normal blood vessels. As your baby grows, so will these blood vessels, and the innocent murmurs will typically go away on their own. Abnormal heart murmurs, on the other hand, are caused by structural issues within the heart, such as stenosis, regurgitation, or vessel outflow/tract narrowing.

To diagnose a heart murmur, a doctor will listen to your child's heart with a stethoscope. If they hear an abnormal sound, they may refer you to a paediatric cardiologist for further tests. These tests may include a chest X-ray, an electrocardiogram (ECG), and an echocardiogram.

The treatment of a heart murmur will depend on the type and severity of the murmur. Innocent murmurs often resolve on their own and do not require treatment. Abnormal heart murmurs may require a more complex treatment approach, which could include medicine, procedures, or surgery.

It is important to follow up with your paediatrician and paediatric cardiologist to ensure that your newborn's heart murmur is thoroughly evaluated and appropriately managed.

A heart murmur may be a sign of an underlying condition that requires monitoring or treatment

A heart murmur is an abnormal sound caused by irregular blood flow through the heart. It can be heard with a stethoscope and is graded on a scale of 1 to 6, depending on how loud it is. While many heart murmurs are harmless, some may indicate an underlying heart condition that requires monitoring or treatment.

Heart murmurs can be present at birth (congenital) or develop later in life (acquired). Congenital heart murmurs are usually caused by structural issues in the heart, such as blocked valves or holes in the heart. These may be indicators of congenital heart disease. On the other hand, acquired heart murmurs can be caused by conditions such as valve stenosis, regurgitation, or vessel outflow/tract narrowing.

It is important to follow up with a paediatric cardiologist if your newborn has received a heart murmur diagnosis. While most heart murmurs in newborns are innocent and often harmless, some may indicate an underlying condition. For example, a newborn with a heart murmur may exhibit symptoms such as slow or delayed growth, cyanosis (bluish extremities or lips), respiratory distress, or sweating during feedings. These symptoms could indicate an underlying heart problem that requires monitoring or treatment.

To diagnose a heart murmur, a doctor will listen to the child's heart with a stethoscope and may refer them to a paediatric cardiologist for further evaluation. Tests such as an echocardiogram, electrocardiogram, or chest X-ray may be ordered to assess the heart's structure and function.

The treatment for a heart murmur depends on its type and severity. Innocent heart murmurs often resolve on their own and do not require treatment. However, abnormal heart murmurs caused by structural issues may require complex treatment, including medication, procedures, or surgery. In some cases, monitoring may be recommended before taking steps to treat the murmur.

Murmurs can be graded on a scale of 1 to 6, depending on how loud they are

Murmurs are graded on a scale of 1 to 6, depending on how loud they are. This grading is based on the volume/velocity of blood flowing through a defect and the distance between the stethoscope and the lesion. For instance, a very thin patient with aortic stenosis and a high-pressure gradient across the valve will have a loud murmur. Conversely, the same valvular lesion in an obese person or someone with severe COPD may be inaudible.

Grade 1 murmurs are very soft and can barely be heard, even by experienced clinicians. Grade 6 murmurs, on the other hand, are extremely loud and can be heard even without the stethoscope touching the chest. They may even be visible.

The grading of a murmur is an important factor in determining the appropriate course of action and diagnosis. For example, when a murmur is more noticeable and can be felt with the palm of the hand over the heart (a "thrill"), it is considered grade 4 or higher.

In addition to the grading, the stage of the heartbeat when the murmur is heard is also important. Murmurs can be systolic or diastolic. Systolic murmurs occur when the heart is squeezing out blood, while diastolic murmurs happen when the heart is filling up with blood.

It is worth noting that many heart murmurs, especially in children, are harmless and are known as innocent murmurs. These murmurs do not require any treatment and may even disappear as the child grows older. However, some murmurs may indicate an abnormality in the heart and require further evaluation and treatment.

A heart murmur can be caused by a blocked valve or a hole in the heart

A heart murmur is a whooshing, swishing, blowing, or rasping sound heard through a stethoscope when blood flows abnormally over the heart valves. It is caused by turbulent or rough blood flow through the heart valves or near the heart. Heart murmurs are quite common and do not always indicate a health problem, especially in children. However, they should be evaluated to rule out any underlying issues.

Heart murmurs can be classified into three types based on their cause and the part of the heart they affect: systolic, diastolic, and continuous. Systolic murmurs occur when the heart muscle contracts, while diastolic murmurs happen when the heart relaxes between beats. Continuous murmurs occur during both contraction and relaxation of the heart muscle.

Systolic murmurs can be further divided into two types: ejection murmurs and regurgitant murmurs. Ejection murmurs occur when blood flows through a narrowed blood vessel or abnormal valve. Regurgitant murmurs occur when blood flows backward into one of the heart's chambers. Diastolic murmurs can be caused by a narrowed heart valve or the backward flow of blood through the heart valves.

A hole in the heart, known as a septal defect, can also cause a heart murmur. This involves the walls (septum) between the upper or lower chambers of the heart. The hole in the septum allows blood to flow through it into the heart's other chambers, causing extra blood flow that may result in a murmur. It can also make the heart work harder or become enlarged. Larger holes can cause symptoms beyond the murmur, while smaller ones may close on their own over time.

While most heart murmurs are innocent and do not require treatment, it is important to evaluate and monitor them to ensure there are no underlying health issues. If a murmur is caused by a blocked valve or a hole in the heart, further investigation and treatment may be necessary.

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