Heart murmurs are common in children and are casued by turbulent blod flow. As a presenting sign they are usually heard during a routine examination or during an intercurrent infection.
When heard during the the neonatal examination they are most frequently due to a closing patent ductus arteriosus or to mild stenosis at the origin of the left pulmonary. Aortic or pulmonary stenosis (including that associated with tetralogy of Fallot) may also present in this way.
In the older child most murmurs are "innocent" and if they exhibit all the clinical characteristics then further investigation is unnecessary.
- Site maximum intensity
- Loudness - scale ranges from 1 to 6 (4/6 have a thrill)
systolic (ejection, mid or pansystolic)
diastolic (early or mid)
- Postural change
- Family history common
- Asymptomatic & the murmur is only abnormal cardiac finding
- Systolic (flow murmur) or continuous (venous hum) - never diastolic
- No thrill
- Flow murmurs (Still’s*) are louder when lying & quieten on sitting
- Venous hums louder when standing & disappear on lying
*Sir George Frederick Still 1868-1941. English Paediatrician