How Serious Are Heart Murmurs in Kids? with Rashmi Rao, MD

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials Podcast. I'm John Horton, your host. Where would your mind go if your child was diagnosed with a heart murmur? You'd no doubt be worried and filled with questions. Is the condition serious? Does a murmur mean your child has a heart defect? Will their physical activity need to be limited? Is your child now at an increased long-term risk for heart disease? To get you answers, we're joined today by pediatric cardiologist, Rashmi Rao. Dr. Rao is one of many experts at Cleveland Clinic who pop into our weekly podcast to share health information that you can trust. Now, let's see if we can put your mind at ease about heart murmurs and your young one. Dr. Rao, thank you so much for being with us here today.

Dr. Rashmi Rao:

Hi, John. Thanks for having me.

John Horton:

So, we've got a lot of questions for you, but as a pediatric cardiologist, I'm guessing that you spend a lot of your day answering questions for anxious parents.

Dr. Rashmi Rao:

That's right. We try to do our best to reassure and make things less scary than they can seem.

John Horton:

Well, and that's why we're here today. We want to try to take some of the scariness out of heart murmurs. So that is something that, if you're in there and you hear that your child has one, I think your first instinct is a deep breath. What is a heart murmur? Let's just start with that.

Dr. Rashmi Rao:

So, a heart murmur is really just an extra sound you hear in addition to the normal lub-dub that you hear when you're listening to someone's heartbeat. And murmurs can be caused by lots of different things. Most murmurs in kids, thankfully, are innocent or benign and don't really correlate with any associated structural heart abnormalities.

John Horton:

So how do they usually sound mean? Is it something that, I mean, you can only hear when you get on your stethoscope or, I mean, do the kids feel it?

Dr. Rashmi Rao:

No, the kids don't feel it. And yes, typically, you really only hear murmurs when you're listening with a stethoscope. There are rare occasions, and usually in bad scenarios, where you can hear a murmur without a stethoscope. But the vast majority of the time, you do need a stethoscope and they have many different sound characteristics. Sometimes, they can be kind of what we call musical or vibratory. Other times, they can sound a little bit harsher. Those are typically ones that we get a little more concerned about and can be associated with some abnormalities in the heart.

John Horton:

Now, when I was reading up on this before our talk, it seems that murmurs are surprisingly common in kids. I mean, is it really that usual?

Dr. Rashmi Rao:

It is. About 60 percent of kids will have what we call an innocent or benign heart murmur at some point during childhood. And typically, those will fade and disappear as the kids get older. But yes, it is a very common finding and one of the most common reasons that kids come to see us.

John Horton:

So, does that mean that it's nothing to worry about? I mean, most of them, when something happens a lot, you go, oh, well, maybe it's not a big deal, but where's the balance there?

Dr. Rashmi Rao:

Sure. So many times, murmurs are really nothing to worry about. Like I said, about 60 percent of kids will have what we call an innocent or benign murmur, and all that means is that it's a sound that you hear, but there's really no correlating abnormality in the heart. And so those are ones we definitely don't need to worry about. Sometimes, there can be a murmur that sounds a little different and can be associated with some kind of structural heart abnormality. And when we hear a murmur that sounds a little more concerning in that sense, then we kind of do a little more investigation with something called an echocardiogram, which is an ultrasound of the heart.

John Horton:

When do you usually pick up on a murmur? Is it during a regular well check or does it usually happen when a child comes in just because they're experiencing a problem?

Dr. Rashmi Rao:

Really, the pediatrician is kind of the first-line screener for murmurs. And so many times, it's just during a routine checkup that a kid is being seen and they happen to notice the murmur. Some murmurs, particularly these innocent ones, tend to be a little bit more prominent and heard more easily by the pediatricians when the child comes in with a fever or some kind of illness. Many times, that's the first time that they hear the murmur. And it can be really at any age, many of the innocent murmurs are really heard for the first time during early school age.

John Horton:

OK, I was going to ask that, whether it was more normal, like early before school, elementary school or even teens. I mean, can it pop up at any time?

Dr. Rashmi Rao:

It can. The most common timeframe though is early school age.

John Horton:

OK. Now, at the start of the podcast, I had mentioned that there were a lot of questions parents have and you kind of answered the first one, which was how serious a heart murmur might be. Let's roll through some of the other ones. And one of the big ones was, does a murmur mean your child has a heart defect?

Dr. Rashmi Rao:

Typically? No. Again, if it's a murmur that has a characteristic sound that qualifies it as an innocent or benign murmur, then no. Those patients do not have a heart defect. And I usually tell parents that when you go to fill out your school forms and it asks you, does your child have a heart problem, say no, because this is not really a heart problem. And these types of murmurs, again, have a very characteristic sound quality to them. So, when I hear a murmur that sounds very much like a musical or vibratory murmur, then I'm very reassured that there's not going to be an actual heart problem in this child. And I don't typically do any additional testing or imaging.

John Horton:

You mentioned the musical sound, so what causes that?

Dr. Rashmi Rao:

So, we don't really fully understand. There's lots of theories, but back in the day, we used to do echocardiograms on these types of children with these murmurs and really never found any correlating abnormality in the heart. So, the sound is really created by some disturbance of blood flow through the heart or the heart vessels. And that can occur for many different reasons, but there's really no steadfast reason why we are hearing these kinds of innocent murmurs.

John Horton:

And then, is that just something that kids outgrow then and that kind of musical interlude kind of disappears?

Dr. Rashmi Rao:

That's exactly right, yes. As they get older, that sound will typically disappear and fade away.

John Horton:

Wow. It's amazing what your body just kind of does on its own. All right, so another question that came up was, if your child has a heart murmur, will their physical activity need to be limited?

Dr. Rashmi Rao:

So again, if we have an innocent murmur and that's what your pediatric cardiologist tells you that your child has, then no, these children should be treated as normal children and really should not have any interference with their ability to play and exercise and do their normal activities. If the heart murmur, however, does lead to a diagnosis of some sort of congenital heart defect, which could mean a hole in the heart or a valve abnormality, then the cardiologist will really give some extensive counseling and education to the child and their family on what their limitations may or may not be.

John Horton:

And it sounds like it is something that's going in that direction, it's something that's detected quickly once you kind of hear the murmur and you know right away.

Dr. Rashmi Rao:

Exactly. So, when I hear a murmur that's concerning, I would immediately have the child undergo an echocardiogram and then I can immediately know what's going on and discuss that with the family.

John Horton:

Would that be that harsh extra sound as opposed to the musical one?

Dr. Rashmi Rao:

Correct. Yeah.

John Horton:

OK. Another question that came up, and I think this is what every parent worries about, if there is a heart murmur, does that somehow make your child more at risk for long term, like heart disease

Dr. Rashmi Rao:

That's a great question, and I bet that's something that a lot of people worry about, but the answer is no. Especially if it's an innocent heart murmur, then there is no increased risk for heart disease or abnormalities down the road and the future. So, if you do have a murmur that's corresponding with an abnormality in the heart, then again, you would receive some pointed education and information from the cardiologist as far as what that might be. But for the vast majority of kids with innocent murmurs, there is no increased risk for the long term.

John Horton:

I have to say the term innocent heart murmur is something that just instantly makes you go, ok, this must not be as terrifying as what I thought.

Dr. Rashmi Rao:

And I bet that's why it was named that.

John Horton:

What other sort of questions do you typically get from parents when they come in and they find out that their child does have a heart murmur?

Dr. Rashmi Rao:

So sometimes, parents will be worried about whether their child can participate in sports. We did allude to that earlier that absolutely, even if the child is diagnosed with a heart defect, we typically almost never restrict patients from participating in sports and activities. Certainly, with more severe illnesses or defects, we might advise that we need to avoid certain activities, but the vast majority of children with murmurs, particularly innocent ones, can participate really in any sport or activity they choose.

John Horton:

And that's always a big worry. I know kids … you want to make sure that they're going to be OK if they're going to go participate in baseball or football or soccer or whatever they want to do. So that's got to be a relief.

Dr. Rashmi Rao:

It is, yeah.

Another question that often comes up is, does my child need to come back and see you? So again, if it's an innocent murmur, we typically will tell the family that they don't need to come back in the future because this is an innocent murmur, and we don't anticipate any long-term issues. If there's a question, we're not sure, we might have the child come back one more time for a visit, just to be sure. And again, if it's a diagnosis where there's a defect involved, then yes, certainly there would be long-term follow-up involved.

John Horton:

And I imagine, too, that's something that their pediatrician would be watching every year when you go in for a well check.

Dr. Rashmi Rao:

Exactly, yes.

John Horton:

All right. Before we say goodbye, is there anything else that you'd like to add or something that we missed on the topic of heart murmurs?

Dr. Rashmi Rao:

Nothing really that we missed. Just that murmurs are usually a sign that there's not usually a sign that there's something bad or scary going on with your child's heart, and hopefully this provides some reassurance for parents out there who are anxious about their child's murmur.

John Horton:

I think it does. So, thank you so much for being with us today and I look forward to having you back on the show.

Dr. Rashmi Rao:

Thank you, John.

John Horton:

So, if your child has been diagnosed with a heart murmur, take a deep breath and get some more information from your family doctor. Heart murmur is a very common condition, and it's not nearly as scary as it sounds. Until next time, be well.

Speaker 3:

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