| Heart murmurs are a very common finding in children, and it is currently thought that up to 50-100% of children will have a murmur at some time in their childhood. Most of these are innocent heart murmurs, which are not associated with any problems in the heart. Innocent murmurs may not always be heard at each doctor visit, and they are more common if your child has a rapid pulse, such as occurs with a fever, after activity or if your child is anxious about being at the doctor's office. They do not require any treatment and children with innocent heart murmurs usually don't need to take antibiotics before dental procedures.
Murmurs can also less commonly be caused by structural abnormalities in the heart, such as a hole in the wall of the heart (ASD or VSD), infections, a faulty valve, or a blockage. These types of murmurs can usually be detected by a detailed physical exam, which will characterize the location of the murmur, how loud or intense it is, its timing, any changes that occur in the murmur after activity or position changes, and will include an examination of your child's liver to see if it is enlarged, and your child's pulses and blood pressure.
Your pediatrician can usually tell if a murmur is an innocent murmur or if it is caused by a problem by a physical exam and by the absence of any symptoms, such as poor growth, difficulty feeding, difficulty breathing, or getting tired easily when exercising in older children. Sometimes, for suspicious murmurs, your doctor may do an EKG or chest x-ray or refer you to a cardiologist, who may do an echocardiogram, but for the majority of innocent heart murmurs no testing needs to be done.
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