Like a River: Heart Murmurs in Children

Damien Kenny, MD, pediatric cardiologist at Rush University Medical Center in Chicago, Illinois.By Damien Kenny, MD

Some of the simplest things we are asked to do often prove to be the hardest. Finding a good analogy for an “innocent” murmur to contextualize for parents is a challenge. A heart murmur is simply an extra heart sound, and at least 30 percent of children will have a murmur at some stage during their childhood. Less than 1 percent of children will actually have something wrong with their heart. However, the word still strikes fear in parent’s minds.

Often good clinical examination is enough to root out the worrisome murmurs from the “innocent” ones, but further testing with an ultrasound of the heart, termed an echocardiogram, can offer further reassurance to patients and their family.

So when I see children and their families and break the good news that thankfully their heart is normal, as it is in the majority of cases, sometimes I am posed with the very natural question of, “Well, what is causing the murmur then?” Most often it is due to rapid blood flow through a growing heart making a “whoosh-like” sound as the blood is pumped across heart valves into the lungs or out into the body.

The best analogy I have found — and the one I am told makes most sense — is relating a young child’s heart to a river near its source. Fast-flowing and energetic, the water often makes noise as it rushes downstream. However, as it gets closer to its destination, the river slows somewhat and sounds of flow disappear. Childhood “innocent” murmurs too usually disappear in adulthood and have no implication for future health.

Ensuring that patients and parents alike are aware of this and able to take comfort and reassurance from what we tell them is, in my opinion, one of the most important aspects of my job.

Damien Kenny, MB, BAO, BCH, MD, is a pediatric cardiologist at Rush University Medical Center.

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