The “lub-dub” sound you hear in a normal heartbeat is the sound of valves closing as the heart squeezes to push blood throughout the body. For some kids, there is an extra sound – a whooshing or swishing either during or between beats. This is called a heart murmur.

For most, it’s just an extra sound

Most heart murmurs are “innocent,” meaning the heart is working properly, but there just happens to be an extra sound. (Kind of like when you hear different noises as water flows through pipes in your home at a varying speed or intensity but it’s still moving along as it should.) The whooshing sound of a heart murmur can be loud or soft, high-pitched or low-pitched.

Innocent murmurs can come and go throughout childhood (adulthood too) and often occur when things like fevers, exercise and growth spurts cause blood to flow more rapidly. Most children have this type of heart murmur.

A child with an innocent murmur won’t typically have any other symptoms because there is no underlying disease or abnormality of the heart. Innocent murmurs are also referred to as functional murmurs as the sound has to do with the heart functioning and not a problem with the heart. They don’t typically cause additional health issues.

Signs to watch for

Much less commonly a murmur can be the sign of a problem in the heart like a hole between the chambers, a leaky valve, or an obstruction or blockage of blood flow. Sometimes kids with these issues also have symptoms such as:

• Rapid breathing
• Difficulty feeding
• Difficulty gaining weight
• Seeming persistently tired

Contact your child’s pediatrician if your child exhibits any of these signs. Be sure to tell the doctor everything you have noticed.

The most common cause of abnormal murmurs is congenital heart defects, which are structural problems of the heart babies are born with. These occur in approximately one in 100 babies.

We’re listening closely too

Doctors regularly check for heart murmurs by listening with their stethoscope as part of well-child exams. If a murmur seems innocent, the doctor will keep an eye (and ear!) out at future checkups. If there is concern about a more serious issue, your doctor may ask you to visit with a heart specialist.

A heart specialist, or pediatric cardiologist, performs a full exam and may order tests to help diagnose the specific cause of the murmur. These tests may include:

• An electrocardiogram which assesses the heart’s electrical activity
• An echocardiogram which uses sound waves to create an image of the heart structure
• A chest x-ray to get a picture of the heart and surrounding organs

Treatment (if needed) depends on a number of factors, including the cause and severity of the murmur, as well as the child’s age and overall health. In some cases, medication can help the heart pump more effectively, prevent blood clots, lower blood pressure and remove excess fluid that can build up in the body when the heart’s not pumping well. In other cases, surgery might be needed to mend a hole in the heart, fix a valve or otherwise address a structural issue.

Heart expertise, right here in Richmond

Doctors in our Children’s Hospital Foundation Heart Center specialize in non-invasive imaging and testing, focusing on the most kid-friendly ways to diagnose and treat conditions in even the tiniest hearts. For many we serve, heart health is a lifelong responsibility. We help prepare families for what to expect and how their child’s condition might evolve as they age to help each child live a healthy, active life moving forward.

By Dr. Brad McQuilkin, cardiologist, Children’s Hospital Foundation Heart Center