Music (Murmurs) of The Heart - Pleasant to Hear and Nothing To Fear

By J. Deane Waldman

Summary
A heart murmur is not a disease or condition: it is simply a noise. Most heart murmurs in children are innocent (nothing at all) or are minor problems that do not require surgery. Think of your child's murmur like music of the heart: pleasant to hear and nothing to fear.

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How should you react if your child's doctor finds a murmur on physical examination? First, do not panic. This is NOT a reason to cry or even to start worrying. If the doctor is worried that the heart problem could be life threatening, she will tell you. Second and most important, heart murmurs in children are usually benign - nothing at all. Finally, in those rare cases when it is something, your child likely has a very minor problem that does not require surgery.

As a pediatric cardiologist, I often hear the following:

• How serious is my child's heart murmur?
• Will he outgrow it?
• They had to operate on my neighbor's murmur, and he died.

A murmur is not a hole in the heart or a leaky valve. It is a noise, not a genetic disorder, a disease, a condition or even a problem. Think of the "murmuring brook" common in storybooks. We murmur sweet nothings in our loved one's ear.

A murmur is caused by blood that does not flow smoothly, what is called turbulence. Imagine the sound of water going over a waterfall: Niagara Falls is very loud. In our minds, we connect these sounds with heart problems because flow through a hole in the heart or through a narrow valve is turbulent and therefore makes noise.

Most children have noises with absolutely nothing wrong with the heart. These are called innocent, benign, or flow murmurs. They can come and go: half of all children will at some time during childhood have an innocent murmur. The sound has a characteristic quality that can be identified by a well-trained pediatric cardiologist. Most of the time, an experienced cardiologist can determine if it is innocent simply by listening. Occasionally, a child will need an echocardiogram, which is the test to take pictures of the heart using sound waves.

Echocardiograms are totally safe. Why don't we do one in every child with a murmur? The simple answer is money. The cost is around $200 per test. The charge is over $1500 and actual payments vary from $75 (a money-loser) to $450 (a profit center).

Your child might have serious heart disease and have no murmur. If the hole in the heart is big enough, there is no turbulence and therefore, no noise. Thus, the doctor cannot use the presence or absence of a murmur alone to determine the presence or absence of heart disease.

This does not mean that listening is useless - quite the opposite. What the doctor hears, in combination with other physical findings, is very helpful in deciding if the child might have a significant problem and might need an echocardiogram or even a heart cath.

Think of your child's murmur like music of the heart: pleasant to hear and nothing to fear.

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