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Consultation with the Specialist

Evaluation of Heart Murmurs

Introduction

As many as 90% of children will have an audible heart murmur at some point in time. However, the prevalence of nontrivial heart disease in this age group is less than 4 per 1000. The practitioner's task is to distinguish the ubiquitous innocent or normal murmur from the murmur indicating heart disease. Normal murmurs include vibratory and pulmonary flow murmurs, venous hums, carotid bruits, and the murmur of physiologic branch pulmonary artery stenosis. Mislabeling of a normal murmur as pathologic may have adverse psychological effects on the family and the child, including unwarranted exercise restrictions and problems later with insurability and employment. Alternatively, failure to identify a pathologic murmur may delay appropriate intervention, especially in early infancy. Recent well-publicized sudden cardiac deaths of professional athletes have augmented the anxiety caused by the specter of heart disease in the young.

Because less than 5% of heart murmurs in children denote cardiac pathology and because each practitioner is likely to see no more than five patients per year who have important heart disease, distinguishing normal from organic murmurs is not always simple. Nevertheless, given the high prevalence of murmurs in the young and because nearly 50% of the patients who have murmurs referred to pediatric cardiologists do have underlying heart disease of variable severity, most clinicians can recognize normal murmurs.

This article has been cited by other articles:

				S. O. Sapin Recognizing Normal Heart Murmurs: A Logic-based Mnemonic Pediatrics, April 1, 1997; 99(4): 616 - 616. [Full Text] [PDF]