Heart murmur, symptoms, children, cardiac, systolic, infant, pregnancy

The heart murmur is an unusual sound that you can hear when listening to the stethoscope in addition to the normal heart sounds.
A linear blood flow is quiet, this noise is produced when the blood flow is restless.

How does the heart work?

The heart consists of 4 chambers: 2 atria and 2 ventricles.

  • The atrium expands to draw blood from the lungs (left atrium) or tissue (right atrium), this phase becomes atria diastole
  • In the meantime, the ventricles pump the blood into the aorta (left ventricle) to the internal organs and into the pulmonary vein (right ventricle), this phase ventricular systole
  • The atrium then pumps the blood to the ventricle on the same side (atrial systole).
  • At the same time, the ventricles expand to accommodate the blood coming from the atria (ventricular diastole).

The heart normally produces two tones: the first heart tone is a low-frequency, muffled tone, which is made by the closing of the mitral and tricuspid valves; the second heart tone is a higher frequency, lighter tone caused by the aortic and pulmonary valves. These two tones follow each other and should not be interrupted by any other tones. The heart murmur is a whistle or whistle, that together occurs with the 1st and 2nd heart sound


  • Heart valve insufficiency = the heart valve does not close well and allows the blood to flow back.
  • Herzklappenprolaps = a flap of the heart valve protrudes in the opposite direction of the blood flow and allows blood to flow back.
  • heart valve stenosis = a narrowing of the heart valve.
  • ventricularseptal = part of the blood flows from the left ventricle to the right.

Classification of heart murmurs

Type of heart murmur by time

Depending on the time of occurrence and the form (or variation of the intensity), the doctor can diagnose the particular heart condition.

Systolic heart murmur (during ventricular systole)

Can be normal or pathological.

Medium systolic outflow heart murmur – starts after the first heart sound and ends before the second.
This noise is caused by the blood flowing through the pocket flaps (anterograd, i.e. forward).
It occurs when the ventricle pumps blood and ends when the blood flow stops.
At the beginning, the heart murmur is delayed in relation to S1. This period will isovolumetric contraction called and corresponds to the time it takes the ventricle to build up a pressure that exceeds the pressure of the aorta.
At this point, the aortic valve is opened by the blood pressure in the ventricle and one hears one "Efflux-click".

The configuration of this heart murmur corresponds to one Diamonds or a diamond (Crescendo-decrescendo) because it increases during the contraction of the ventricle and wanes during relaxation.


  1. Aortic or pulmonary stenosis, with an aortic stenosis you can hear the heart murmur even at the level of the carotid arteries.
  2. Expanded aortic or pulmonary artery.
  3. Increased flow through a normal heart valve (due to anemia, hyperthyroidism, etc.).

Late systolic murmur (in the final phase of systole) – It starts between the beginning and the middle of the systole with a click that corresponds to the tension of the tendon chordae of the heart valve.
A characteristic of this heart murmur is that its intensity is constant until the end of systole.

The reasons for this can be:

  1. Prolapse of the mitral or tricuspid valve
  2. Dysfunction of the papillary muscle

With a mitral valve prolapse you can hear that clicking not immediately after S1, but in the middle of the systole.
This sound corresponds to the maximum tension of the chordae tendineae, i.e. the time at which the prolapse of the heart valve stops.

The following features are important for the diagnosis of prolapse:

  • The click in the middle of the systole
  • The constant intensity

Holosystolic or pansystolic heart murmur (from the beginning to the end of systole) – starts at S1 and extends to S2.

The cause can be:

  1. Mitral valve or tricuspid valve insufficiency
  2. Interventricular or interatrial septal defect

If the mitral valve is normal, the pressure in the left ventricle causes the heart valve to close because it is higher than the pressure in the atrium.

With mitral regurgitation (with prolapse), the blood returns to the left atrium during the entire contraction of the ventricle and causes it constant heart murmur.

As the ventricle pushes the blood into the atrium, it expands over time to absorb the returning blood.
As a result, the atrium can absorb more blood at the same blood pressure.
This heart murmur radiates up to the armpit.

Diastolic murmur (during ventricular diastole)

This disorder is always pathological.

Types of diastolic murmurs

Protodiastolisch – Starts together with S2, which corresponds to the closure of the pocket flaps (aortic and pulmonary valve) and ends before S1.
The reasons for this can be:

  • Pulmonary and aortic valve insufficiency
  • Expansion of the heart valve ring

Because the aortic valve does not close completely, blood returns to the ventricle during diastole, where blood pressure is lower.

Ventricular pressure rises rapidly because the volume of blood it contains increases because:

  1. The atrium pumps blood into the ventricle
  2. A small blood flow emerges from the aorta

Therefore, the heart murmur is stronger at the beginning and then becomes weaker: descending.
Aortic insufficiency is seen along the left sternal margin, while pulmonary valve insufficiency is audible at the upper right margin of the sternum.

diastolic roll – starts after S2 (closing the aortic valve) and ends at S1.

In the first phase of diastole, the ventricle fills up very quickly because the pressure difference between the atrium and the ventricle is greater (stronger heart murmur).
You hear one clicking (Opening noise) because the stenotic flap is stiff, and finally the lock is heard when the opening reaches its limit.
At the end of the diastole, the atrium contracts to pump the blood into the ventricle. The consequence is one Accentuation of the heart murmur in the presystolic phase (presystolic reinforcement).
The cause is a mitral or tricuspid valve stenosis.
The diastolic rolling can be heard in the mitral area.

Causes of the physiological heart murmur

The physiological heart murmur is caused by the blood flowing through the heart and coronary arteries faster than normal (ejection murmur of the heart); it can be caused by:

  • physical activity,
  • age,
  • fever,
  • anemia,
  • Hyperthyroidism (hyperthyroidism)
  • Infarction (one of the main causes in adults),
  • Thoracic trauma,
  • palpitations,
  • pregnancy.

Abnormal or pathological heart murmur

The abnormal or pathological heart murmur can have the following causes:

  • Congenital defects (existing since birth) at heart. A child can be born with valve defects and defective blood vessels. Other anomalies concern septal problems.
  • infections. Pathogenic germs damage the heart valves and other structures of the organ.
  • Rheumatic fever. Rheumatic fever is a serious disease caused by bacteria, especially streptococci. It causes:
  • Sore throat,
  • fever,
  • Scarlet fever.

The heart structures can be permanently damaged.
endocarditis. Endocarditis is an inflammation of the inner robe >

Symptoms of heart murmurs

Some heart murmurs indicate a heart problem and possible symptoms are:

  • Blue coloring (cyanosis) of the fingers and inside of the mouth,
  • rapid breathing,
  • excessive sweating,
  • chest pain,
  • dizziness,
  • difficulty in breathing,
  • fatigue,
  • powerlessness,
  • nausea,
  • Swelling of the legs and feet,
  • rapid weight gain,
  • chronic cough,
  • enlarged liver,
  • enlarged neck veins.

Diagnosis of heart murmur

The cardiologist is able to diagnose a heart murmur by auscultating the heart. He can also order examinations; are best suited:

  • Echocardiogram and Doppler sonography,
  • chest X-ray,
  • Electrocardiogram (EKG).

To determine whether the heart murmur is pathological, the Classification according to Levine applied, which divides the heart murmur into 6 degrees:

  • 1/6 very quiet, only audible in certain positions,
  • 2/6 quiet,
  • 3/6 moderately loud,
  • 4/6 very loud,
  • 5/6 very intense,
  • 6/6 also audible when the stethoscope is slightly lifted off the chest wall.

Therapy for heart murmurs

Benign heart murmurs do not need treatment because the heart is healthy.

Abnormal heart murmurs are treated with the heart disease they cause. These sounds are treated with drugs and surgically.
Medications prescribed by the doctor are:

Surgery is used to replace a defective heart valve or correct congenital anomalies or septal defects.

Sport and prevention

Preventing a heart murmur is important.

  • Follow a low-fat diet to reduce cholesterol.
  • Quit smoking as smoking increases your cardiovascular risk.
  • Avoid high blood pressure.

In the event of a physiological or harmless heart murmur, the doctor recommends a young person to do his favorite sport in order to improve cardiovascular health.
With a pathological or malignant heart murmur, exercise can also be dangerous for athletes.

Heart murmur in newborns

About 85% of children have a heart murmur in the first 24 hours after birth, but this disappears in the following 48 hours. These noises are caused by the volume of the blood vessels: newborns have a lot small Arteries, veins and capillaries.
After birth, blood flows to the lungs (for the first time) and causes "turbulence".
A heart murmur can:

  • be harmless or
  • pathological: symptom of a heart defect.

There are no special symptoms of harmless (physiological or functional) heart murmur in infants. Serious symptoms can only be observed if the cause is a congenital defect. In 90% of cases of heart murmurs in newborns, it is a functional type.

Benign heart murmurs: This type of sound is called functional heart murmur, it is a sign of a healthy heart and is created by the sound of the blood flowing through the heart. No therapy is needed. It is very common in children.

Heart murmur due to congenital heart defects: It is the result of an abnormality in the heart structure. The heart murmur is a result of structural problems in the heart, in this case the heart murmur is pathological.
This includes:

  • Valvular heart anomaly
  • cardiomyopathy
  • septal

Septal defects are caused by holes in the heart wall. The hole can cause additional blood flow.
Cardiomyopathy is a heart muscle disorder in which the heart muscles are thickened and yet weakened. The result is a change in how the heart works.

If the doctor suspects that the heart murmur is caused by heart problems, further examinations can be carried out, such as:

  • electrocardiogram,
  • chest X-ray,
  • echocardiogram.

During pregnancy, the health of the mother can affect the health of the child. Does the mother suffer from:

or has problems with alcohol abuse, increases the risk of pathological heart murmur in the child.

heart murmur
© Massimo Defilippo

Therapy for heart murmurs in newborns
The treatment of the heart murmur depends on the cause.
There is no need to worry about physiological or harmless heart murmurs because they are not dangerous and do not need to be treated.
If the heart defect is congenital and diagnosed by laboratory tests, the newborn needs surgery.

Heart murmurs in newborns are fairly common and are not a serious health problem. Parents observe symptoms such as:

  • anorexia,
  • accelerated breathing,
  • growth retardation,
  • excessive sweating,
  • bluish lips and nails,

you should see a pediatrician to clarify the cause of the heart murmur.

The cause may be a botalli duct, which is a small hole that connects the pulmonary artery to the aorta and that can cause heart problems.
This congenital defect is more common in premature babies (around 40%).
Among the heart murmurs in children there is also the foramen ovale persistens, which is a small opening between the right and left atria of the heart.

Heart murmur in children

Older children may have a heart murmur. Some children have very fine chest walls, in which case the heart murmurs can be heard. That kind of heart murmur will functional called (or benign) heart murmur. The parents do not have to worry about this noise.

  • In some cases, the heart murmur can be caused by stress, anemia, or fever.
  • Tight blood vessels can also make an abnormal sound.

If you hear a loud noise, further examinations may be necessary. X-rays are taken to show any heart defects.
An electrocardiogram confirms that the heartbeat is normal.

At a benign heart murmur no therapy is required.
There are very rare cases where the heart murmur can cause serious heart problems.
There are risks and complications among them that can also lead to death.

As a rule, benign heart murmurs decrease over time.
The sounds become less audible as the chest wall increases in thickness.


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Christina Cherry
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