Are childhood heart murmurs problems?

Is a childhood heart murmur something to worry about? Not necessarily, says Dr. Angelo S. Milazzo, a pediatric cardiologist and medical director of Duke Children's Consultative Services of Raleigh. A heart murmur usually is only a sound made by a heart that is otherwise healthy and normal.

As many as 50 to 75 percent of all children will have an audible murmur at some point in childhood. Normal heart murmurs are heard in many children of all ages, but they are particularly common in young infants, preschoolers and adolescents. A normal murmur may be heard throughout childhood, or it may disappear at any time. In most cases, a normal murmur will disappear completely at some point in childhood, although some persist into adulthood. Certain conditions (such as fever, anemia, exercise, pregnancy, and changes in body position) may change the way a normal murmur sounds, making it easier or more difficult to hear.

In the case of a child with a normal heart murmur, nothing more than a comprehensive physical examination is usually needed to make the diagnosis. During the examination, the physician carefully notes the qualities of the murmur — the area of the body where it is heard best, the volume or intensity of the sound, the quality of the sound, and other features.

A heart murmur is the sign of an abnormal heart or cardiac disease in only a very small number of children. In an even smaller number of children is a heart murmur the sign of life-threatening cardiac disease. In these cases, the quality of the murmur itself, combined with other features of the patient’s examination and medical history, will provide a significant clue that underlying cardiac disease is present. If an abnormality is suspected, the patient will very likely be referred for evaluation by a pediatric cardiologist.