Benign paediatric heart murmur
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
A benign paediatric heart murmur, also innocent heart murmur or innocent murmur, is an inconsequential sound that originate from the heart and/or cardiovascular system and is heard on cardiac auscultation. By definition, an innocent murmur is not significant in the long-term health of an individual that has it.
Murmurs - innocent versus pathological
Characteristics of innocent murmurs are:
- Less than 3/6 in intensity, soft
- Often position-dependent (supine versus upright)
- Otherwise healthy individual, no concerns about growth
- Continuous (throughout cardiac cycle) or systolic (diastolic-only sounds are always pathologic)
- Normal S2 splitting (S2 splitting with inspiration)
- No palpable thrill (vibration of the chest due to abnormal heart movement/blood flow)
Prognosis
Innocent murmurs are inconsequential and usually disappear as the child grows. ECG and Chest XRAY are normal.
Types, description and DDx
| Name | Location | DDx |
|---|---|---|
| Still's murmur | inferior aspect of LLSB, systolic ejection sound, vibratory/musical quality | subaortic stenosis, small VSD |
| Pulmonary ejection | superior aspect of LLSB, ejection sound | Pulmonary stenosis, atrial septal defect |
| Venous hum | Infraclavicular throughout the cardiac cycle (right side > left side), diminishes with jugular vein palpation or neck turning | PDA |
| Supraclavicular arterial bruit | Above clavicles | aortic stenosis, bicuspid aortic valve |
| Peripheral pulmonary stenosis | low-pitch with radiation to back and armpit | PDA, pulmonary stenosis |
LLSB = lower left sternal border
See also
External links