Heard a heart murmur

[nursekoll, BSN, RN]

Just needing a little reassurance guys, because heart murmurs have burned me before. I heard a definite heart murmur at the left sternal border of a 10-year old kid that came in for headache and nausea with low-grade fever. I'm not even sure what prompted me to assess heart sounds other than this kid just didn't look right (skin was an off-color maybe). I heard it while student was both supine and sitting up. Had another nurse listen as well, just to make sure I wasn't hearing things. She heard it too. Called parent because of course I have no history on this student. Parents report JRA history "but he's outgrown it" and they never knew of any heart murmurs though all the testing that was done several years ago. I recommend they get it checked out because it's a new finding. They agree. After going to the doctor they call to report to the school secretary that there is no murmur. I know I heard it and I wasn't the only one who did. Now I'm questioning myself, and wondering if they're mad that I sent them for what turned out to be an unnecessary appointment. Any other perspectives on this??

[OldDude]

Don't change a thing...what if you had NOT said anything and the kid woke up dead a few days later; you'd feel pretty bad about that. I've heard, and reported, many, what sounded to me, abnormal heart sounds that turned out to be nothing.

And, as we know, those things can be transient/temporary, innocent in nature, and due to chemical changes due to diet, exercise, etc., especially in kids.

My principal came in the other day and said he visited a NP for an illness who told him he had a heart murmur. I listened and it sounded like a horse galloping to me. I asked him about his diet and he said he was a few days into some weird "purging" diet. I told him to stop it and get back on a regular diet. He followed my advise, came in the next week and his heart sounded normal and regular as a clock.

[Amethya]

How can you hear one? How does it sound like?

[nursekoll, BSN, RN]

Instead of the typical lub-dub sound it was a definite lub-du-dub. And sort of a whoosh on the second double-beat. Anyone have a better description??

[ruby_jane, BSN, RN]

3 minutes ago, nursekoll said:

Instead of the typical lub-dub sound it was a definite lub-du-dub. And sort of a whoosh on the second double-beat. Anyone have a better description??

Nope, that catches it! I haven't heard of heart murmurs that are transitory. My PVCs are transitory but they don't sound like a murmur. Regardless....you heard something that was not WNL. You spoke to the parent, they said that there was at one point something to worry about and took the kid to a doctor. Your job is done. And a good job you did!!!

[UrbanHealthRN, BSN, RN]

I'm not sure how old this student was, but I know that with young children, transient heart murmurs sometimes happen, and fever can be one of the causes. These murmurs are called "innocent murmurs", and I remember noticing them once in a while when I worked at the children's hospital. There's no way I can explain it properly, but this site from the UK does a pretty good job: https://www.gosh.nhs.uk/conditions-and-treatments/general-medical-conditions/heart-murmurs-innocent

More importantly, though, good catch nursekoll! An abnormal finding is exactly that, and as nurses all we can do is advocate for follow-up with our kids. I'm glad the family went to the doctor. Bummer that the doc didn't notice the murmur, but again, it doesn't mean it didn't exist.

[NRSKarenRN, BSN, RN]

Audio demonstrations: Heart Sounds & Murmurs

https://www.luriechildrens.org/en/specialties-conditions/heart-murmur/

[Amethya]

Thank you! This is interesting.

[SaltineQueen]

18 hours ago, Amethya said:

How can you hear one? How does it sound like?

There's a whoosh instead of the typical lub-dub. You can google heart and lung sounds. There's lots of audio clips out there.

[aprilmoss]

The poster above characterizes it pretty well, but even the pathological murmurs can change over time. But still, if you hear one you should let the parents know so they can follow up with their pediatrician.

[T-ROD, LPN]

My son has a murmur that he has had since birth. Cardio always told me that when he is ill you will be able to hear it the best. Normal days you really don't.

Definitely something to notate and keep in the back of your mind. You did right by contacting and passing on the info.

[rnsrgr8t]

I am a PNP and I work in a specialty. I occasionally will hear an innocent sounding murmur when I examine my patients. I always let the families know and ask them to f/u with the PCP. A lot of times, the PCP does not hear it. Innocent murmurs come and go and are more pronounced with fever/illness. That is likely what this child had. Trust your assessment skills!