Heart murmur in a child: is it dangerous and when is echocardiography needed - examination in Tashkent

What is noise and where does it come from?

Normally, the doctor hears two tones through a phonendoscope - the sounds of valves closing. A murmur is an additional sound between tones that occurs when the blood flow ceases to be strictly laminar and begins to swirl. There are two reasons for swirling: either there is an obstruction or hole in the blood's path that shouldn't be there, or the blood is simply flowing faster than usual through normal structures.

• The second option is functional, or innocent, noise - the heart is completely healthy
• In children, the chest wall is thin, and the heart is located close, so any sounds are heard more clearly than in adults
• The heart rate in children is higher, the blood flow speed is higher - physiology itself predisposes to the appearance of noise
• Pathological noise is associated with a septal defect, narrowing or insufficiency of the valve, open duct

Why functional noise is not dangerous

Functional murmur does not affect the functioning of the heart and does not interfere with the child’s growth, playing sports and living a normal life. It does not turn into a vice, does not require treatment, restrictions or a special diet. The best-known variant is Still's noise, a soft, musical sound most often heard in children 3–8 years of age.

• Heard inconsistently: today there is, in a month there is no
• Intensifies with rising temperature, after running, with excitement
• Becomes louder when lying down and gets weaker while sitting and standing
• Appears or worsens with anemia - due to decreased blood viscosity and accelerated blood flow
• More often heard in thin children and during periods of rapid growth
• The child is completely healthy: develops normally, does not get tired, does not turn blue, and gains weight well

What worries the doctor

An experienced doctor focuses not only on the fact of the noise itself, but also on its characteristics and the overall picture. The following signs are considered alarming.

• The noise is loud, rough, scraping, felt by the hand as a trembling of the chest wall
• The murmur is diastolic - that is, heard in the relaxation phase of the heart; such noise is practically never functional
• The noise occupies the entire systole and does not change with changes in body position
• The noise is carried out in the axillary region, on the back or on the vessels of the neck
• The murmur was heard for the first time in a newborn
• The murmur is associated with shortness of breath, cyanosis, poor weight gain, fainting, or chest pain on exertion
• Family history of congenital heart defects, cardiomyopathy, or sudden cardiac death at a young age

Special case: murmur in a newborn

In the first days of life, the heart is rebuilt from intrauterine circulation to normal: the oval window closes, the ductus arteriosus closes, and the pressure in the vessels of the lungs decreases. Because of this restructuring, some of the noises in the maternity hospital sound completely different from what they will sound like in a month, and some defects, on the contrary, do not appear immediately.

• The murmur on the first day is often associated with the ductus arteriosus that has not yet closed and may disappear on its own
• Some serious defects make no noise at all in the first hours of life, because the pressure in the pulmonary vessels is still high
• Conversely, noise sometimes appears only at the end of the first week or by the first month - this is a natural course of events, and not a deterioration
• In premature infants, patent ductus arteriosus is noticeably more common and requires separate monitoring.
• For a child in the maternity hospital, blood oxygen saturation is measured in the arm and leg - a simple test that helps identify critical defects before noise appears

That is why noise in a newborn is not put off until later: the child is examined, the pulse in the femoral arteries is checked, skin color and breathing patterns are assessed, and, if necessary, echocardiography is performed. Older children usually do not have this urgency.

When is echocardiography needed?

1. Шум впервые выслушан у ребёнка первого года жизни — особенно в роддоме или в первые недели.
2. Есть любой of симптомов: одышка, синюшность, утомляемость при кормлении, обмороки, боль в груди при нагрузке.
3. Характеристики шума нетипичны для функционального — грубый, диастолический, проводящийся.
4. Ребёнок отстаёт в физическом развитии или плохо прибавляет в весе.
5. Планируется серьёзная спортивная нагрузка или предстоит операция под наркозом.
6. Родители сохраняют тревогу — это тоже достаточная причина: однократное исследование снимает вопрос на годы.

Echocardiography in a child takes about 20–30 minutes, does not require injections, preparation and does not involve radiation exposure. It is often given to infants during sleep or feeding. An ECG complements the picture, but does not replace an ultrasound: a normal ECG does not exclude a defect.

What should parents do?

1. Не паниковать и не искать диагноз по описанию шума в интернете — на слух порок не ставится.
2. Уточнить у педиатра, какой шум он слышит и рекомендует ли эхокардиографию.
3. Сделать ЭхоКГ, если она назначена, и сохранить заключение с распечаткой — это база для сравнения в будущем.
4. Проверить общий анализ крови: анемия — частая и легко устранимая причина усиления шума.
5. Не ограничивать ребёнка в движении и не освобождать от физкультуры до получения результата обследования.
6. При нормальной ЭхоКГ спокойно жить дальше: повторять исследование ежегодно «на всякий случай» при функциональном шуме не требуется.