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Guide Understanding Pediatric Heart Sounds

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When listening to newborns shortly after birth, murmurs created by the rapidly changing physiology of the cardiopulmonary circulation can frequently be heard.

"Innocent" Heart Murmur

The infant here is 3 hours old. The murmur that can be heard above, loudest along the left sternal border, is consistent with a patent ductus arteriosus PDA. Although pathologic PDA is classically described as a continuous "washing machine-like" murmur, when PDA is present just after birth, as part of a normal transition, it usually occurs as a soft systolic murmur which disappears in a few hours or a few days.

When listening to the left chest where the lung sounds are louder, notice the rapid respiratory pattern. At the time of this recording, the infant's respiratory rate was ; this patient had transient tachypnea of the newborn. In this case, the murmur was physiologic and unrelated to the tachypnea, but congenital heart disease should always be considered when a murmur occurs in combination with respiratory symptoms. The most common cardiac abnormality encountered in the newborn nursery is an isolated VSD.

The murmur is frequently not heard at birth, but as the ductus arteriosus closes and the pressure gradient between the two ventricles becomes greater, a harsh murmur at the lower left sternal border can be heard, often on day 2 or 3. Although this diagnosis can be frightening to parents, many VSDs will close spontaneously over the course of several weeks to months. It has a harsh, jet-like quality and is systolic.

Heart Murmur: What to Expect if Your Child is Diagnosed

Although VSD murmurs are typically described as holosystolic, this can be difficult to appreciate in a newborn. Here, both S1 and S2 are clearly heard.


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In this case, the harsh systolic murmur can be heard across the precordium, but again is loudest and most distinct along the left sternal border. As with any VSD, infants should be followed for signs of congestive heart failure and SBE prophylaxis used until the defect closes. This murmur was created by a small muscular VSD also known as swiss cheese defect.


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This murmur was not noted on the initial examination, but on the second exam, it was easily appreciated when the infant was quiet. Here is another recording of a small muscular VSD. In this patient, there is a high-pitched blowing component heard at the beginning of the murmur over the left sternal border. When the stethescope is moved either to the aortic area right sternal border or over the apex left chest this aspect of the murmur disappears.

Clinical Guidelines Hypoglycemia Vitamin K. Newborn Exam Barlow and Ortalani Manuevers. Normal Heart Sounds. Sinus Arrhythmia. Patent Ductus Arteriosus.


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  8. Ventricular Septal Defect 1. Ventricular Septal Defect 2. Ventricular Septal Defect 3. Ventricular Septal Defect 4. Normal Heart Sounds Here is a recording of normal heart sounds in an infant. Most murmurs are not a cause for concern and won't affect a child's health at all. Doctors listen to the heart by putting a stethoscope on different areas of the chest.

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    It helps if kids are quiet as the doctor listens, because some heart murmurs are very soft. It's not unusual for a murmur to be noticed during a routine checkup, even if none was heard before. Heart murmurs are rated on a scale from 1 to 6 based on how loud they are. Grade 1 is very soft, whereas grade 6 is very loud. If a murmur is found, the doctor may refer a child to a pediatric cardiologist for further evaluation. The most common type of heart murmur is called functional or innocent.

    Understanding Pediatric Heart Sounds

    An innocent heart murmur is the sound of blood moving through a normal, healthy heart in a normal way. Just as you might hear air moving through an air duct or water flowing through a pipe, doctors can hear blood moving through the heart even when there's no heart problem. An innocent heart murmur can come and go throughout childhood. Kids with these murmurs don't need a special diet, restriction of activities, or any other special treatment. Those old enough to understand that they have a heart murmur should be reassured that they aren't any different from other kids.

    Some murmurs can indicate a problem with the heart. In these cases, doctors will have a child see a pediatric cardiologist.

    Heart Murmurs - Akron Children's Hospital video

    The cardiologist will order tests such as:. About 1 out of every babies is born with a structural heart problem, or congenital heart defect. These babies may show signs of the defect as early as the first few days of life or not until later in childhood.