Heart murmurs in children

Features of an innocent murmur

  • Location – left sternal edge
  • Variability with position
  • Good perfusion, pulses
  • Growing and feeding normally
  • No signs of heart failure – hepatomegaly, failure to thrive, recurrent respiratory infections (typical signs in adults not present in this age group e.g. crackles, peripheral oedema, raised JVP)

 

Data gathering

  • History – Infant: growth, feeding, breathing, recurrent respiratory infections, sweating, blue episodes, family history
  • History – Older child: chest pain, palpitations, exercise intolerance, syncope, leg oedema, family history
  • Examination
    • Obs: RR, HR, CRT
    • CVS: location of murmur, intensity, positional, systolic, peripheral pulses (inc femoral)
    • Abdo: hepatomegaly

 

Clinical management

  • Investigations
  • Treatment
  • Follow-up / Safety-net
    • Refer to paediatrics
      • Urgent – if red flags on history or examination
      • Routine – if likely innocent murmur