Diagnosis and Management of Heart Murmurs in Children

The physician taking care of children must meet the problem of an easily audible heart murmur almost every day. In order to do so, the physician must be able to perform an excellent cardiovascular examination, should have an approach to making the differential between abnormal and normal murmurs, and should be able to figure out what the common cardiac lesions sound like. If one places an intracardiac phonocatheter at the root (origin) of the pulmonary artery or root of the aorta in all nondiseased people, a heart murmur will be documented (Figs 1 and 2).1-3 This murmur is present for two reasons: (1) because the origin of each great artery is narrower than the ventricle which ejects the blood into it, and (2) because each great artery arises from the ventricle at an angle. A useful analogue to explain the normal murmur to families is to suggest that they go to the basement of their home, find a water pipe, and listen with ears close to the pipe. As the water goes through the pipe it can easily be heard, and, of course, that is a murmur. If one finds the input to that water pipe and turns the spigot such that the space for the entering stream is narrowed, that murmur will become louder; and if then one finds an angle in the pipe where turbulence is likely, the murmur is again recognized to be louder.