Introduction

The heart is a part of the circulatory system and is a muscular organ made up of four chambers separated by walls and valves. Now the right half of the heart collects blood that is depleted of oxygen that is your venous blood, via the veins and sends it to the lungs to pick up oxygen. The left half of the heart collects this oxygenated blood, which is your arterial blood, and pumps it via the arteries to the rest of the body for oxygen uptake. Now the valves in the heart allow for blood flow in one direction within the heart and out of it via the blood vessels. Now the closure of these heart valves produces heart sounds which is what is heard by your doctor with the stethoscope. The normal heart sounds are “lubdub lubdub”. Any additional sound heard is called a murmur that is lubsshdub lubsshdub. Now a murmur is produced by the turbulence of blood flowing through the heart and the blood vessels. A murmur can be innocent or abnormal. Now innocent heart murmurs, also known as functional murmurs, are produced by the flow of blood in a normal heart and blood vessel. Most murmurs in healthy infants, children, and adolescents are innocent and do not produce any symptoms and are detected by a doctor in a routine physical exam.

Characteristics
These innocent murmurs have the following characteristics. They are vibratory and have a soft quality. They are often in short in duration. They can vary in position and breathing. They can become louder with exercise, anxiety, or fear. If your doctor is convinced it is an innocent murmur, then no further workup is required. Sometimes these murmurs disappear by adolescence and it does not require a child to be restricted from any physical activity.

Symptoms
If your child has any of the worrying signs, it could indicate a heart defect. These worrying signs in infants include breathing fast, poor feeding, excessive sweating with a poor suck, poor weight gain, a bluish discoloration of the lips. In older kids, these worrying signs can be difficulty keeping up with physical activity, palpitations, growth delay, dizziness or fainting spells and bluish discoloration of the lips and the nail beds. Now your child is referred to the paediatric cardiologist when your child has any of these worrying symptoms we discussed, or if your doctor is not convinced or is unsure that the murmur is being innocent. If an infant less than a year old is having a murmur, either with or without any associated symptoms, they definitely need to see the cardiologist.

Diagnosis
Now some of the investigations your paediatric cardiologist will perform include a thorough physical exam and blood pressure recordings from all the four limbs, a pulse oximetry which is to check the oxygen saturation, and a chest x-ray. He may do an EKG and an echocardiography which is an ultrasound of the chest to assess the heart structure.
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