Innocent murmur

Question 1

What is an innocent murmur?

Answer 1

Functional or physiological murmurs are benign heart sound in healthy children
Generally remain harmless and resolve over time without any long term consequences

Question 2

What is the epidemiology of innocent heart murmur?

Answer 2

Very common - 1/3 of children
Mostly incidental findings

Question 3

What is the aetiology of innocent murmurs?

Answer 3

Normal flow of blood through the heart and vessels
More prominent during rapid growth, physical activity or acute illness.

Question 4

What is Stills murmur?

Answer 4

A type of innocent murmur
Systolic heart best on the left sternal edge - loudest when lying supine

Question 5

What is a venous hum?

Answer 5

A machinery murmur heard on both sides of sternum due to flow of blood through the great veins

Is an innocent murmur

Question 6

What is a flow murmur?

Answer 6

Seen during acute infective illness
Short systolic murmur on left sternal edge with resolves with the fever
Innocent murmur

Question 7

What are the key features of an innocent murmur?

Answer 7

The 6 S’s
Soft - faint volumne
Systolic - all diastolic are pathological
Sensitive - change with position or respiration
Short - not all systole
Single - no additional sounds
Small - localised and does not radiate to other areas

Otherwise asymptomatic

Question 8

What are the key investigations for an innocent murmur?

Answer 8

Normally clinical diagnosis

If concerned may be pathological -> pulse oximetry, ECG, echo, CXR

Question 9

What is the key management of an innocent murmur?

Answer 9

Reassurance of family and child
Review child after a few weeks if presented during illness -> see if murmur also resolved

Question 10

What is the prognosis of an innocent murmur?

Answer 10

Considered benign
No associated complications or implications for quality of life