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Innocent Cardiac Murmurs

Benign and Innocent Cardiac Murmurs


Presentation

  • This comprehensive, easy to understand book is a ready guide to acquiring the proficiency and confidence necessary to decipher the wide spectrum of disease presentations.[books.google.com]
  • Stenosis - when the valve doesn't open enough and blocks blood flow Valve problems can be present at birth or caused by infections, heart attacks, or heart disease or damage.[icdlist.com]
  • At present it would be impossible to cope with referring all children with innocent murmurs for echocardiography. It could be argued that it is sensible to refer these children to a paediatric clinic.[gponline.com]
  • Some pathologic (non-innocent) heart murmurs present soon after birth, while others may not present until later in life.[sharecare.com]
  • Some are a sign of a heart problem, especially if other signs or symptoms of a heart problem are present. Types of Murmurs Innocent (harmless) murmurs.[blackdoctor.org]
Atrial Septal Defect
  • NIH: National Heart, Lung, and Blood Institute Atrial septal defect (Medical Encyclopedia) Bicuspid aortic valve (Medical Encyclopedia) Congenital heart defect corrective surgeries (Medical Encyclopedia) Congenital heart disease (Medical Encyclopedia)[icdlist.com]
  • However, I have seen three major lesions - atrial septal defects, coarctation of the aorta and hypertrophic cardiomyopathy - missed by both GPs and paediatricians. These lesions often have only soft murmurs.[gponline.com]
  • septal defect Venous hum Infraclavicular throughout the cardiac cycle (right side left side), diminishes with jugular vein palpation or neck turning PDA Supraclavicular arterial bruit (Systemic Flow Murmur) Above clavicles aortic stenosis, bicuspid aortic[en.wikipedia.org]
  • Heart murmurs may be heard in a normal healthy heart of a child, or they may be caused by a number of factors or diseases, including: Defective heart valves Holes in the walls inside the heart (atrial septal defect or ventricular septal defect) Other[stanfordchildrens.org]
  • Presentation of atrial septal defect in the pediatric population. Pediatr Cardiol. 2005;26(6):812–814. 20. Syamasundar Rao P. Diagnosis and management of acyanotic heart disease: part I — obstructive lesions.[aafp.org]
Weight Gain
  • But regular review of feeding and weight gain are needed and the parents should be told to make contact if there is any sign of poor colour, breathlessness or difficulty feeding. In my view, it is best for GPs to refer these cases.[gponline.com]
  • Article Summary X While many adult heart murmurs are nothing to worry about, see your doctor if you have any symptoms, like swelling in your legs, unexplained weight gain, shortness of breath, chest pain, or swollen veins in your neck.[wikihow.com]
  • Poor weight gain/FTT Family history of cardiac lesions, early or unexplained death or drowinging under 35 years of age In infants - feeding difficulties, tachypnea, irritability, sweating Older children- exercise intolerance, syncope, presyncope, palpitations[pedclerk.bsd.uchicago.edu]
  • gain Enlarged liver Enlarged neck veins Signs and symptoms depend on the problem causing the heart murmur and its severity.[thehearthospitalbaylor.com]
Asymptomatic
  • If an infant is asymptomatic it may be reasonable to wait for the murmur to disappear, if ECG and chest X-ray are normal, and this is the approach of many paediatricians.[gponline.com]
  • Heart murmurs are common in asymptomatic, otherwise healthy children.[aafp.org]
  • Investigations chest X-ray and electrocardiography are very rarely useful in deciding if a murmur is innocent and are no longer indicated as routine investigations for children with asymptomatic murmurs.[gpnotebook.com]
  • Neonates with heart murmurs who are clinically asymptomatic should also be referred for a routine echocardiographic assessment.[patient.info]
  • Chest roentgentogram in the evaluation of heart defects in asymptomatic infancts and children with a cardiac murmur: reproducibility and accuracy. Pediatrics, 103(2):e15. Cincinnati Children's. Signs and symptoms: heart murmur. Harris, J.P. (1994).[pedclerk.bsd.uchicago.edu]
Coarctation of the Aorta
  • However, I have seen three major lesions - atrial septal defects, coarctation of the aorta and hypertrophic cardiomyopathy - missed by both GPs and paediatricians. These lesions often have only soft murmurs.[gponline.com]
  • ., Marfan syndrome) Turner syndrome is associated with increased risk of coarctation of the aorta, aortic valve stenosis, and left ventricular hypertrophy Inborn error of metabolism Marfan syndrome is associated with mitral valve prolapse, aortic root[aafp.org]
  • […] of the aorta Patent ductus arteriosus (PDA) Ventricular septal defect (VSD) Multiple murmurs may result from a combination of heart problems.[medlineplus.gov]
  • Better pulses in the upper upper extremities than the lower extremities is suggestive of coarctation of the aorta.[pedcard.rush.edu]
  • […] of the aorta (CoA), aortic stenosis (AS), patent ductus arteriosus (PDA) with pulmonary hypertension Upper right sternal border AS, supravalvular AS, subaortic stenosis Lower left sternal border Ventricular septal defect (VSD), Still's murmur, hypertrophic[patient.info]
Feeding Difficulties
  • Your infant will be observed for changes in skin color (turning blue), as well as breathing or feeding difficulties. He also may undergo additional tests, such as a chest X-ray, electrocardiogram (ECG), and an echocardiogram.[healthychildren.org]
  • Poor weight gain/FTT Family history of cardiac lesions, early or unexplained death or drowinging under 35 years of age In infants - feeding difficulties, tachypnea, irritability, sweating Older children- exercise intolerance, syncope, presyncope, palpitations[pedclerk.bsd.uchicago.edu]
  • Physical Examination of Children with Heart Murmurs Finding Significance Abnormal growth (height and weight plotted on growth chart) Feeding difficulties may be a sign of cardiac disease in newborns and infants (decreased exercise capacity) Certain genetic[aafp.org]
  • Infants with pulmonary overcirculation or decreased cardiac function present with increased sweating with feeds, increased time to finish the feed, or they might take multiple breaks while feeding.[healio.com]
Tachypnea
  • Tachypnea and a hyperdynamic precordium, and feeding problems should also trigger consideration of an underlying cardiac lesion thus attention to the cardiac exam in neonates is very important. References Birkebaek, N.N. et. al. (1999).[pedclerk.bsd.uchicago.edu]
  • Failure to thrive (FTT): Poor feeding secondary to pulmonary edema and poor cardiac output as well as increased caloric expenditure due to tachycardia and tachypnea will eventually lead to FTT.[pedcard.rush.edu]
  • Tachypnea and increased respiratory effort could indicate structural heart disease. Heart rate and rhythm should be assessed. It is important to feel all peripheral pulses and to look for any brachiofemoral delay.[healio.com]
  • […] may be a sign of cardiac disease in newborns and infants (decreased exercise capacity) Certain genetic disorders may increase risk of delayed growth and CHD Abnormal vital signs (compared with age-adjusted norms) Arrhythmia, tachycardia, hypoxia, and tachypnea[aafp.org]
Regurgitation
  • Sometimes it causes regurgitation. Stenosis - when the valve doesn't open enough and blocks blood flow Valve problems can be present at birth or caused by infections, heart attacks, or heart disease or damage.[icdlist.com]
  • These abnormal murmurs can be caused by: Problems of the aortic valve ( aortic regurgitation, aortic stenosis) Problems of the mitral valve ( chronic or acute mitral regurgitation, mitral stenosis ) Hypertrophic cardiomyopathy (idiopathic hypertrophic[medlineplus.gov]
  • Mitral regurgitation - the mitral valve separates the left atrium from the left ventricle. Mitral regurgitation means the mitral valve doesn’t close properly, allowing blood to backtrack into the atrium.[betterhealth.vic.gov.au]
  • The most common heart conditions causing murmurs in infants include ventricular septal defects (VSDs), patent ductus arteriosus (PDA), aortic/pulmonary valve stenosis/thickening or mitral/tricuspid regurgitation (MR/TR).[sharecare.com]
  • Continued Mitral or aortic regurgitation: In this case, regurgitation means the blood is going the wrong way through your mitral or aortic valve and back into your heart.[webmd.com]
Failure to Thrive
  • Failure to thrive, poor growth, difficulty feeding. Abnormal symptoms such as breathlessness, frequent chest infections (indicate high blood flow to the lungs), unable to keep up with friends.[gponline.com]
  • Central cyanosis or heart failure should prompt urgent specialist referral even if there are no murmurs. cyanosis or clubbing abnormal breathing (tachypnoea, intercostal recession) failure to thrive abnormal pulses - diminished or absent femorals abnormal[gpnotebook.com]
  • Some kids won't have any symptoms beyond a heart murmur, while others will such signs as: rapid breathing difficulty feeding blueness in the lips (called cyanosis) failure to thrive An older child or teen might: be very tired have trouble exercising or[kidshealth.org]
  • If your child has a heart murmur and any of these symptoms, call your doctor: rapid breathing difficulty feeding failure to thrive blue tint to the lips. These could be signs of a more serious heart problem.[familydoctor.org]
  • Failure to thrive (FTT): Poor feeding secondary to pulmonary edema and poor cardiac output as well as increased caloric expenditure due to tachycardia and tachypnea will eventually lead to FTT.[pedcard.rush.edu]
Vomiting
  • […] heart failure, which is present in approximately one-third of infants and children with CHD. 4 The most common symptoms in a series of children presenting to the emergency department with acute heart failure included dyspnea (74 percent), nausea and vomiting[aafp.org]
Heart Murmur
  • The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. But many people have heart murmurs without having a problem.[icdlist.com]
  • However, this could mean up to half of all UK children being seen in hospital for a soft heart murmur.[gponline.com]
  • murmur Innocent murmur ICD-10-CM R01.0 is grouped within Diagnostic Related Group(s) (MS-DRG v 36.0): 306 Cardiac congenital and valvular disorders with mcc 307 Cardiac congenital and valvular disorders without mcc Convert R01.0 to ICD-9-CM Code History[icd10data.com]
  • A heart murmur is not a disease. Most heart murmurs do not mean anything is wrong, but occasionally they are a sign of a heart problem. Are there different kinds of heart murmurs? Heart murmurs are classified as either normal or abnormal.[childrenscardiology.org]
  • People of any age can have a heart murmur and the condition may come and go throughout a person's lifetime. Types of Heart Murmur Heart murmurs are classified in two ways: innocent and abnormal.[healthcommunities.com]
Heart Disease
  • Heart Diseases in Children: A Pediatrician's Guide is divided into four sections. The first is an overall approach to heart diseases in children with ample discussion to diagnostic testing.[books.google.com]
  • […] defect (Medical Encyclopedia) [ Read More ] Heart Valve Diseases Also called: Valvular heart disease Your heart has four valves.[icdlist.com]
  • Every topic and chapter has been revised and updated to reflect the latest medical and surgical treatments for all congenital and acquired heart diseases. New surgical approaches, including hybrid procedures, have been updated.[books.google.com]
  • Other warning signs include: When there is a family history of congenital heart disease, cardiomyopathy or sudden death. Failure to thrive, poor growth, difficulty feeding.[gponline.com]
  • The unusual sounds of a heart murmur aren’t classic heart disease symptoms, but they could indicate trouble nonetheless. If you’ve ever been told you have a heart murmur, you may be inclined to immediately think you have heart disease.[universityhealthnews.com]
Heart Disease
  • Heart Diseases in Children: A Pediatrician's Guide is divided into four sections. The first is an overall approach to heart diseases in children with ample discussion to diagnostic testing.[books.google.com]
  • […] defect (Medical Encyclopedia) [ Read More ] Heart Valve Diseases Also called: Valvular heart disease Your heart has four valves.[icdlist.com]
  • Every topic and chapter has been revised and updated to reflect the latest medical and surgical treatments for all congenital and acquired heart diseases. New surgical approaches, including hybrid procedures, have been updated.[books.google.com]
  • Other warning signs include: When there is a family history of congenital heart disease, cardiomyopathy or sudden death. Failure to thrive, poor growth, difficulty feeding.[gponline.com]
  • The unusual sounds of a heart murmur aren’t classic heart disease symptoms, but they could indicate trouble nonetheless. If you’ve ever been told you have a heart murmur, you may be inclined to immediately think you have heart disease.[universityhealthnews.com]
Systolic Murmur
  • Pulmonary flow murmur Pulmonary flow murmur is a soft systolic murmur, which unlike Still's murmur, is heard at the upper left sternal edge and is harsher and higher pitched and can be heard over the child's back.[gponline.com]
  • murmur NOS benign R01.0 functional R01.0 innocent R01.0 nonorganic R01.0 ICD-10-CM Codes Adjacent To R01.0 Q99.2 Fragile X chromosome Q99.8 Other specified chromosome abnormalities Q99.9 Chromosomal abnormality, unspecified R00 Abnormalities of heart[icd10data.com]
  • […] examination - pulmonary diastolic murmur On examination - pulmonary systolic murmur On examination - systolic murmur On examination - systolic murmur at apex On examination - tricuspid murmur Organic heart murmur Pansystolic murmur Plateau cardiac murmur[icd9data.com]
  • Innocent Heart Murmurs – Hard Description Type Description Age at detection Aortic systolic murmur Systolic ejection murmur best heard over the aortic valve Older childhood into adulthood Mammary artery soufflé* High-pitched systolic murmur that can extend[pediatric-house-calls.djmed.net]
  • Six cardinal signs are described which indicate that a systolic murmur is likely to be pathological, ie because of an underlying heart defect.[patient.info]
Systolic Murmur
  • Pulmonary flow murmur Pulmonary flow murmur is a soft systolic murmur, which unlike Still's murmur, is heard at the upper left sternal edge and is harsher and higher pitched and can be heard over the child's back.[gponline.com]
  • murmur NOS benign R01.0 functional R01.0 innocent R01.0 nonorganic R01.0 ICD-10-CM Codes Adjacent To R01.0 Q99.2 Fragile X chromosome Q99.8 Other specified chromosome abnormalities Q99.9 Chromosomal abnormality, unspecified R00 Abnormalities of heart[icd10data.com]
  • […] examination - pulmonary diastolic murmur On examination - pulmonary systolic murmur On examination - systolic murmur On examination - systolic murmur at apex On examination - tricuspid murmur Organic heart murmur Pansystolic murmur Plateau cardiac murmur[icd9data.com]
  • Innocent Heart Murmurs – Hard Description Type Description Age at detection Aortic systolic murmur Systolic ejection murmur best heard over the aortic valve Older childhood into adulthood Mammary artery soufflé* High-pitched systolic murmur that can extend[pediatric-house-calls.djmed.net]
  • Six cardinal signs are described which indicate that a systolic murmur is likely to be pathological, ie because of an underlying heart defect.[patient.info]

Workup

  • “Heart murmurs don’t always require treatment, but they deserve a full workup and ongoing surveillance,” says Carabello. “And if you eventually do need a valve replacement, the outcomes are excellent.” WHAT YOU CAN DO Get informed.[nydailynews.com]
  • Evaluation of murmurs [ 11 ] Systolic murmurs Midsystolic: Grade 2 or less: Asymptomatic and no associated signs – no further workup. Symptomatic or other signs of cardiac disease - echocardiogram. Grade 3 or more - echocardiogram.[patient.info]

Treatment

  • Many children with congenital heart defects don't need treatment, but others do. Treatment can include medicines, catheter procedures, surgery, and heart transplants.[icdlist.com]
  • Every topic and chapter has been revised and updated to reflect the latest medical and surgical treatments for all congenital and acquired heart diseases. New surgical approaches, including hybrid procedures, have been updated.[books.google.com]
  • This unique book is a go-to resource for pediatricians, pediatric residents, family practitioners, medical students and nurses, conveying essential information for the diagnosis and treatment of pediatric heart diseases.[books.google.com]
  • […] existing at the time of initial encounter that proved to be transient and whose causes could not be determined; (c) provisional diagnosis in a patient who failed to return for further investigation or care; (d) cases referred elsewhere for investigation or treatment[icd10data.com]
  • For abnormal murmurs, however, treatment may be necessary. There are a couple possible treatments for heart murmurs: Medications: This depends on the specific heart issue you have.[reverehealth.com]

Prognosis

  • For people with other types of heart murmurs, the prognosis depends on the type of heart problem and its severity. In general, even when heart surgery is required, the prognosis is good.[womenshealthmag.com]
  • Prognosis [ edit ] Innocent murmurs are inconsequential [4] and usually disappear as the child grows. ECG and Chest XRAY are normal.[en.wikipedia.org]
  • Prognosis Many heart murmurs are considered harmless and are left untreated. These are known as innocent heart murmurs. Prognosis for abnormal heart murmurs depends on the type and severity of the heart problem causing them.[baptisthealth.com]
  • Follow up with, “What’s my prognosis?” or “What’s my prognosis without an intervention?” Once you’ve reached the point where it’s time for a valve replacement, ask, “What are my options?”[nydailynews.com]
  • Prognosis Most children with innocent heart murmurs grow out of them by the time they reach adulthood. Severe causes of heart murmurs may progress to severe symptoms and death. Key terms Atria — The upper two chambers of the heart.[medical-dictionary.thefreedictionary.com]

Etiology

  • Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'.[icd10data.com]
  • The exact etiology of Still's murmur has not been clearly defined yet. It has been proposed that it originates from increased velocity of flow as blood is pumped into the aorta from the left ventricle.[healio.com]

Prevention

  • In most cases, you can't prevent heart murmurs. The exception is that if you treat an underlying condition, such as high blood pressure, or you avoid heart valve infection, heart murmurs are stopped before they start.[webmd.com]
  • Prevention There is no way to prevent the congenital heart defects that cause some heart murmurs.[womenshealthmag.com]
  • Can you prevent a heart murmur? Most heart murmurs are normal, and there is nothing you can do to prevent them or cause them. They just happen. Most abnormal murmurs cannot be prevented, either.[myhealth.alberta.ca]
  • ACE inhibitors) Lower cholesterol (e.g. statins) Can a heart murmur be prevented? Heart murmurs can not usually be prevented. However, most murmurs are innocent (harmless) and do not cause any health problems.[mydr.com.au]
  • Can a heart murmur be prevented or avoided? There is nothing you can do to prevent heart murmurs caused by genetic causes. Avoiding drugs and alcohol and receiving treatment for infections during pregnancy can prevent some heart murmurs in children.[familydoctor.org]

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