Boom, boom. Boom, boom. That is the sound of our heart with each beat.
Boom, boom. Boom, boom. That is what all mothers expect to hear in the 6-8 weeks of gestation, and every time that they go through a checkup during pregnancy. It is the sound of life.
And that is what we pediatricians are lucky to hear every time that we use the phonendoscope to auscultate your child, what indicates us the rhythm of his/her heart.
But, what happens when we find a murmur in the heart as well? What is that? Is it important? Why does the emergency physician tell me that my child has a murmur when the pediatrician has never told me anything about it?
The murmur constitutes the first reason to refer a child to the pediatric cardiologist. It is a “noise” that we pediatricians can hear when we auscultate the child’s heart, and most of the times it is of no significance. In that case we call it “innocent murmur” and it is found roughly in 3 out of 4 healthy children, and that is the reason why many times the pediatrician does not comment about it.
The identification of a cardiac murmur, and its characterisation as innocent or not, could be compared to listening to music. It is necessary to pay attention to its intensity, tone or frequency, timbre, wavelength and duration. And it is the pediatrician’s and/or the cardiologist’s task to determine if that murmur seems really innocent or if it can hide a congenital heart disease, that is to say, a heart disease. But this is not always easy, since it requires, in addition to knowledge and experience, a silent environment and time, which very often are absent by the excessive healthcare work found in consultations or emergency services. Even in the best conditions and with a good auscultation, a small percentage of cardiac pathologies “escape” us.
But, what must I do if a murmur is detected in my child’s heart? As simple as following the pediatrician’s indications. Most cases of innocent murmurs appear or vary according to the position of the child, and increase their intensity when the heart rate increases, for example with fever, nervousness or after exercising. It is thus that many times it is detected, or the parents are informed about it, in an emergency service, when, for example, the child has fever or bronchitis, although very probably the pediatrician had already described it as innocent and was doing a clinical follow-up.
Then, how can it be confirmed that a murmur is innocent or warns us of that 2% of congenital heart diseases which cannot be detected by auscultation? The answer is to make a cardiac ultrasound scan, an innocuous test which is similar to the ultrasound scans in pregnancy, and which is performed by children cardiologists, or adult ones with experience with children. By means of this test we are able to see the heart and its structures, and check if that “small noise” is due or not to some alteration in it and, if necessary, we can refer the child to a centre specialized in congenital heart diseases where the pathology will be dealt with.
So, in general, it is necessary to convey calm to mums and dads when the pediatrician informs them of a murmur in the heart, because, besides being nothing important many times, we can always confirm it with an echography and obtain the result in about 15-30 minutes.
In fact, the American Heart Academy recommends to perform an echocardiogram in all children under the age of 2 years having a cardiac murmur although the child does not have any symptoms, or at any age if there were doubts regarding its nature.
Whatever to be able to listen with calm to that sound that gives us peace since we are in the maternal womb: boom, boom. Boom, boom.Published on 25 february 2012 in Diario Información of Alicante