What to look out for when a child has a heart murmur

In fact, children's resistance is relatively poor, much worse than that of adults, so in daily life, they must pay attention to their physical health. Otherwise, it is very likely that children will have heart murmurs. Let us now learn about the precautions for children with heart murmurs.

①The time when the noise occurs. Late systolic, holosystolic, and diastolic murmurs all have pathological significance.

②The location and conduction of the noise. Different heart diseases produce murmurs that are loudest in different locations and have different conduction ranges, which are related to the location of the lesion, the direction of blood flow, and the properties of the medium that transmits the murmur to the body surface. For example, the murmur of mitral stenosis is loudest at the apex and is generally rarely transmitted. The murmur of mitral regurgitation is loudest at the apex of the heart and travels toward the axilla.

③The intensity of the noise. Systolic murmurs can be divided into four or six grades when auscultated, and the six-grade classification is more commonly used in clinical practice. Grade 1 murmurs are of no significance and can be heard in the aortic valve area and apex in normal people. However, murmurs of grade three or above usually indicate organic lesions in the heart and blood vessels, such as valvular heart disease, congenital heart disease, fever, etc. The amplitude of the main wave S1 at the apex is often used as the standard in the phonocardiogram. Murmur amplitude ≥ S1 amplitude is considered significant, <1/3 S1 amplitude is considered mild, equal to 1/2 S1 is considered moderate, and only weak vibration is considered very weak.

④Noise frequency. Frequency is directly proportional to pressure difference and flow velocity and inversely proportional to flow rate. The frequency of high-frequency noise is above 120Hz, the frequency of medium-frequency noise is 60~120Hz, and the frequency of low-frequency noise is 30~60Hz. A murmur that is mainly high-frequency sounds like blowing on the ear, while a murmur that is mainly low-frequency sounds like rumbling on the ear.

⑤The shape of the murmur on the phonocardiogram. Depending on the pathological basis of the murmur, there are consistent type, increasing type, decreasing type, diamond type, continuous type, irregular type, musical type, etc. (Figure 2).

⑥ The effects of breathing, body position, Valsalva maneuver (forced exhalation after closing the glottis), exercise, changes in cardiac cycle length, and certain drugs that affect hemodynamics. Generally, the murmur is clearer in the lying position than in the sitting or standing position, and the intensity of the murmur increases after exercise and when blood flow is accelerated. Sometimes the murmur of mitral stenosis is difficult to hear in the normal position. It can only be heard after turning to the left lateral position, especially after 6 to 10 heartbeats just after turning. The murmur of tricuspid stenosis or regurgitation intensifies during inspiration, while the physiological systolic murmur may disappear during inspiration.

The above article has given you a detailed introduction to the precautions for children with heart murmurs. I believe that everyone has a relatively preliminary understanding, so in daily life, it is still necessary to discover such problems in time and then conduct further examinations.