Elsevier

Journal of Pediatric Nursing

Volume 29, Issue 6, November–December 2014, Pages 700-702
Journal of Pediatric Nursing

Clinical Practice Department
Innocent Murmurs and Pediatric Patients: When Should the Primary Care Provider Refer?

https://doi.org/10.1016/j.pedn.2014.06.007Get rights and content

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What is a Murmur?

Cardiac murmurs are the sounds produced by the vibrations caused by turbulence of the blood flow in the heart (Naik & Shah, 2014). The number of turbulence-causing vibrations and the intensity of the murmur depend on blood volume and pressure differences (Naik & Shah, 2014). Murmurs may also be caused by normal blood flow through normal cardiac structures (Burns et al., 2013). The murmur gets its name from the extra or unusual sound that is heard during a heartbeat; murmurs have many different

History and Physical Examiantion

To make a decision about whether or not to refer a patient for further evaluation of a heart murmur, the provider must obtain a thorough family and medical history as well as a thorough physical examination including a cardiac examination. Past medical history and family history are important, including information about members of the family with a history of sudden cardiac death or congenital cardiac defects. A patient who has a first-degree relative with a sudden cardiac death at a young age

How to Classify Murmurs

The classification of all murmurs is crucial to deciding whether further evaluation is warranted and to alleviating unnecessary anxiety to parents. The pediatrician or provider should classify the type of murmur using four characteristics: timing, duration, location, and intensity (Naik & Shah, 2014). Systolic murmurs are graded on a six-point scale. A grade one murmur is barely audible, a grade two murmur is louder, and a grade three murmur is loud but not accompanied by a thrill, a grade four

How Murmurs are Diagnosed

The diagnosis of an innocent heart murmur can be made if four criteria are met: absence of abnormal physical examination findings (except the murmur), a negative review of systems, a negative history and family history, and auscultation findings that are consistent with those for an innocent murmur (single, short duration, small, soft, not harsh, and systolic) (Frank & Jacobe, 2011). A cardiologist should evaluate newborns within 1 to 2 days of noticeable signs or immediately depending on their

When to Refer

For primary care providers in pediatric offices, determining whether a murmur is innocent or pathologic can be intimidating and cause anxiety for the provider and the patient's family. Therefore, deciding when to refer for further evaluation is important. If a provider is concerned that a murmur may be pathologic, the provider will refer the patient to cardiology for further evaluation. If a referral is being placed, it is not cost-effective to perform any further testing in the primary care

Conclusion

Many children develop a heart murmur during childhood, and the majority are innocent murmurs that come and go with age and growth. A new murmur can create anxiety for the primary care provider as well as the family, and deciding whether the murmur is pathologic or innocent is extremely important in the event that a referral is necessary. Family support is extremely important to help both the family and the patient understand the diagnosis and how to cope (Burns et al., 2013). Referral is

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There are more references available in the full text version of this article.

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