Murmurs can be challenging to diagnose in adults, as well as in children unless they are easily heard. “Although most are not pathologic, a murmur may be the sole manifestation of serious heart disease” (Frank, Jennifer, & Jacobe, Kathyrn, 2011). Since murmurs may be the only symptom pointing to serious heart complications, it is essential to follow up and have further testing done when one is first detected.
In this scenario, a grade II/VI systolic murmur is detected in a 16 yr old male athlete. “This means the murmur is grade 2 on a scale of 1 to 6 (“Medline Plus, 2019). The patient is in a slightly recumbent position, which can also affect the way the murmur sounds. There are several things to consider when a murmur is detected for the first time, especially in an adolescent. Does the murmur occur during systolic or diastolic contraction? Does the murmur change when the patient moves? Can it be heard in other areas, such as the neck, back or the chest? Also, where is it the loudest? Depending on the answer to these questions, the patient might need to be referred to a cardiologist for further testing.
It also states in the scenario that there is no family history of premature cardiac death, but it does not state that there is no cardiac history in the family. The patient and the parents would need to be questioned further to see what the extent is, if any, of any cardiac disease. They also need to be questioned to see if there is a history of congenital heart disease, maternal diabetes, exposure to alcohol or drugs while in utero, any genetic disorders, and history of Kawasaki disease or rheumatic fever. If the patient or family member has any one of these or a combination of them, it is cause for alarm, and the patient needs to be screened for a more serious heart condition.
Behavior can also play a part in heart murmurs in adolescents. The patient would need to be examined while doing physical exercise to see if he has any breathing difficulties and to see how his heart acts under physical exertion and stress. If the patient becomes short of breath or the murmur increases to a 3 or above, these are big red flags and could indicate an underlying cardiac condition. These are not conclusive that there is more going on, it could be that the child is overweight or out of shape, but it is better to have the child examined by a cardiologist to make sure there is nothing wrong with his heart. The cardiologist will most likely order a chest x-ray and an echocardiogram. “Echocardiogram (also called “echo” or cardiac ultrasound): sound waves create an image of the heart” (Children’s Hospital of Philadelphia, 2018). The Echo will be the most conclusive test to determine if there are any abnormalities with his heart. If I were the provider for an adolescent who presented with a murmur for the first time, I would do a thorough examination, including all of the questions and tests described above. If anything during these were abnormal, I would refer him to a pediatric cardiologist to determine if there is anything wrong with his heart.
References
Children’s Hospital of Philadelphia (2018). Heart murmur in children.
Frank, Jennifer, & Jacobe, Kathyrn (2011). Evaluation and management of heart murmurs in children. American family physician. https://www.aafp.org/afp/2011/1001/p793.html
Medline Plus (2019) Heart murmurs https://medlineplus.gov/ency/article/003266.htm.
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