A Clinical Approach to Pediatric Heart Murmurs
How to diagnose a heart murmur in a child?
Sounds that are heard between heart sounds - the thump of muscle contractions - are called murmurs. They should not be in a healthy heart.
Why are there noises?
The mechanism of heart murmur is that pathological changes in the heart muscle or the great vessels surrounding the heart cause their narrowing or reverse blood flow.
This happens for various reasons: for example, a defect in the formation of cardiac septa or a narrowing of the great vessels in the pathology of heart valves. Distinguish between systolic and diastolic murmurs. Systolic murmurs in the heart of a newborn are not considered dangerous, they occur during the adaptation period during the final formation of the organic system.
The causes of diastolic murmurs need to be clarified in detail - they indicate pathology.
For the first time, the state of the cardiovascular system is assessed immediately after childbirth. If violations are detected, additional examinations are prescribed - ECG and X-ray. Babies are re-examined at the age of one month - ultrasound is added to the hardware diagnostics - and 3 times upon reaching a year. If the child belongs to a risk group, during this time violations can be identified and the necessary measures taken.
The heart - structure and function
The functions of the heart are known: it drives blood through the body, saturating it with oxygen. If it stops, life is interrupted. But how does it work?
The heart consists entirely of muscle tissue. There are 4 chambers inside the organ: atria - left and right, ventricles - also left and right.
The chambers are separated by partitions, and the atrioventricular valves - mitral and tricuspid - are located between the atria and the ventricles. The vessels that extend from the ventricles also have valves. The left ventricle is equipped with an aorta with an aortic valve, the right ventricle with a pulmonary artery with a tricuspid valve.
Heart sounds that we hear in the form of a pulse or, pressing against the chest, with the ear, are sounds that are emitted by valves, rhythmically closing. When the heart muscle relaxes - diastole - the chambers are filled with blood, the left ventricular valve opens; in systole, blood is expelled from the chambers into the vessels -the tricuspid valve contracts.
Why is there a heart murmur in a newborn?
The causes of a heart murmur in a newborn are disturbances in the work of the heart, when its tones change the nature of the sound or intensity.
This happens in such cases:
- if turbulence occurs, normal blood flow is impaired;
- the flow rate changes if the holes in the valves, ventricles or septa are abnormal in size;
- with congenital heart defects;
- due to valve stenosis or insufficiency;
- with minor developmental anomalies - improper positioning of papillary muscles or tendon strings - if they are deviated from their normal position, then vortices are formed in the bloodstream;
- if there is a congenital defect - a duct in the area between the heart septa or an extra vessel between the arteries.
During the prenatal period - until the lungs work - the fetus needs ducts between the ventricles. But they should close at the first breath. A heart defect appears with underdevelopment or pathology of the cardiovascular system.
Functional or harmless murmurs occur in 40% of infants. They are detected in the first days after birth and pass on their own, their appearance is justified by the adaptation of the body to extrauterine conditions of existence. Hardware examination does not reveal any pathologies.
Pathological noises. Their presence may be accompanied by the following symptoms: cyanosis, shortness of breath, shortness of breath or rapid breathing; or just listen during the examination. If hardware diagnostics did not reveal significant changes, very often doctors take the position of observers - this is how adaptation proceeds or latent malformations manifest themselves. The baby is examined 1-2 weeks after birth, depending on the general condition, and then a decision is made whether treatment is needed or not.
Congenital murmurs are detected in the first hours of a baby's life. Their causes - developmental defects - are found out immediately. People can live their whole lives with a minor vice. If the concomitant symptoms with heart murmurs in a newborn are respiratory and reflex insufficiency, cyanosis or cyanosis of the skin, developmental delay, then treatment should be started immediately after the pathology is detected. In most cases, surgical interventions are performed.
A heart murmur can also be acquired in nature - a baby can get sick immediately after birth, or get complications from an infection in the first year of life.
Against the background of infection, the inflammatory process engulfs the heart valves, which causes dysfunction of the heart. One of these acquired pathologies is rheumatism.
Even a small heart murmur in a newborn requires seryegreat attention. If a baby is diagnosed with it at birth, diagnostic measures must be started to determine the mechanism of the pathology.
Anamnesis is studied - genetic factors, bad habits of parents, the course of pregnancy is analyzed - if there is a possibility of a cardiac disease, it must be identified from the very beginning.
The baby is referred for a consultation with a cardiologist, and hardware diagnostic procedures - ECG, ultrasound, heart X-ray, EchoCG with Doppler ultrasonography - are repeated.
What examinations are needed is determined by the doctor. If pathologies are detected, a therapeutic scheme is developed and the necessary therapeutic measures are prescribed.
Elimination of cardiovascular disorders
There is no specific treatment for heart murmurs. The decision is made by the doctor for each small patient individually, based on an assessment of the clinical picture.
Conventionally, babies in the first year of life are divided into 3 categories.
- 1 - heart pathology is incompatible with life. They are immediately sent to a cardiology and hospital for the necessary treatment. If the correction of intrauterine pathology has been successful, in the future such children are prescribed supportive therapy and they are registered with a cardiologist;
- 2 - concomitant pathologies interfere with the operation. There are quite a few newborns of groups 1 and 2 among all babies - about 15%. It is very disappointing that most parents themselves are to blame for this outcome - bad habits against the background of unhealthy heredity or acquired diseases, pathology arises in the formation and development of the cardiovascular system in the fetus;
- 3 is the largest group. Cardiological disorders in infants are minimal, and if, with dispensary observation and treatment, the development of disorders can be slowed down - in the future, children can lead a normal life.
Parents should not panic when detecting heart murmurs in babies. At the current level of development of medicine, most developmental disorders are corrected in the first year of life with the help of drug treatment or cardiac surgery.
In the future, minimal adjustments will be enough, and the child will begin to lead a normal life. Its quality depends entirely on the attention and economic capabilities of the parents.