Infant Journal
for neonatal and paediatric healthcare professionals

Investigating heart murmurs in neonates and children: reinvigorating the art of clinical medicine

Heart murmurs are common in neonates and children; however, it is important to differentiate between an innocent murmur and a pathological murmur. Heart murmurs can arise from abnormalities of the cardiac valves and other cardiac structures resulting in abnormal, turbulent blood flow that causes an audible extra sound. Nowadays, clinicians rely more on an echocardiogram than on their clinical skills, yet careful auscultation of heart murmurs can characterise the nature of a murmur and aid the diagnosis of many cardiac conditions. This article reviews the role of heart murmurs in congenital heart disease, and how to evaluate and characterise heart murmurs. A comparison of pathological heart murmurs is provided along with a description of investigations and suggestions for when to refer heart murmurs for detailed cardiac assessment, which includes an echocardiogram.

Vikranth Bapu Anna Venugopalan
Consultant Neonatologist with expertise in Paediatric Cardiology Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust

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heart murmur; echocardiogram; congenital heart disease
Key points
  1. It is important to distinguish a pathological heart murmur from an innocent murmur.
  2. A thorough clinical examination can identify those patients with pathological murmurs that might benefit from cardiology referral for an expedited detailed cardiac assessment, which includes an echocardiogram.

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