Heart Murmur

How should I initially evaluate and manage my patient?

Initial Evaluation

Gather appropriate history, family history and perform a physical examination. Concerning elements are age dependent, for example an infant who has excessive sweating while eating is concerning. An adolescent with exercise induced chest pain is concerning. For older children, dynamic assessment of the heart murmur is important (listening to the heart in different positions).

Initial Management:

If the patient is asymptomatic with benign family history and has the following characteristics* to the heart murmur then no further cardiac evaluation is needed. The patient has an innocent heart murmur which is a normal variation. If during upcoming evaluations, the characteristics of the heart murmur changes, then please refer to cardiology.

* The Seven “S” of Innocent Murmurs: (Bronzetti et al. Clin Pediatr (Phila). 2010 Jul;49(7):713)

Systolic (apart from venous hum)
Small (limited area)
Soft (low amplitude)
Short
Single (no clicks or gallops)
Sweet (never harsh)
Sensitive (to posture) (does not increase with standing up from sitting or squatting)

When should I refer my patient?

How can I refer my patient?

What can my patient expect from a visit to Children’s National?

The cardiologist and their staff will obtain a detailed history including family history and perform an examination. They might also obtain an echocardiogram. An echocardiogram is a test that uses sound waves (ultrasound) to create images of the heart. A Doppler test uses sound waves to measure the speed and direction of blood flow. By combining these tests, a pediatric cardiologist gets useful information about the heart’s anatomy and function. Echocardiography is the most common test used in children to diagnose or rule out heart disease.