Heard a heart murmur

[nursekoll]

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??

[ruby_jane, BSN, RN]

We need a @Davey Do graphic - the innocent murmur versus the guilty murmur....

[Davey Do]

2 hours ago, ruby_jane said:

We need a Davey Do graphic - the innocent murmur versus the guilty murmur....

Thank you, ruby jane, I enjoy creating graphics to assist my sistren and brethren in understanding the difference between innocent and guilty murmurs.

Bear in mind that these are merely interpretations, but with professionals like nursekoll who called in a suspect, someday we may be able to identify and deal with all guilty murmurs!

[NRSKarenRN, BSN, RN]

Good info from CHOP: Children's Hospital of Philadelphia

Symptoms that Might Indicate a Heart Problem

[OldDude]

1 hour ago, Davey Do said:

Thank you, ruby jane, I enjoy creating graphics to assist my sistren and brethren in understanding the difference between innocent and guilty murmurs.

Bear in mind that these are merely interpretations, but with professionals like nursekoll who called in a suspect, someday we may be able to identify and deal with all guilty murmurs!

Of course...all murmurs are innocent until proven guilty.

[LibraSunCNM, BSN, MSN, CNM]

So interesting to learn that a murmur is more pronounced or transient when a child is sick!

[bluebonnetrn, BSN, RN]

21 hours ago, rnsrgr8t said:

Trust your assessment skills!

^ this right here is the BEST summary of what school nursing really is

[NutmeggeRN, BSN]

So, think about it this way, what if you heard what you heard, did NOT report it, and the kid has a medical mevent...how do you explain that??

[CampyCamp, RN]

Fever is known to produce innocent murmurs because it increases cardiac output- blood rushing faster through the heart produces turbulence (the murmur) even though the structures are normal. It would have been nice if the PCP had told the family that so they understood why something was heard once and not again.

[ruby_jane, BSN, RN]

37 minutes ago, CampyCamp said:

Fever is known to produce innocent murmurs because it increases cardiac output- blood rushing faster through the heart produces turbulence (the murmur) even though the structures are normal. It would have been nice if the PCP had told the family that so they understood why something was heard once and not again.

And I learned a thing today! Thank you.

[Wuzzie]

42 minutes ago, CampyCamp said:

It would have been nice if the PCP had told the family that so they understood why something was heard once and not again.

But what would be the fun in that? Now the parents think the PCP is super smart and the nurse doesn't know what she's doing. ?

[OldDude]

Here's another one...one of our previous students is the daughter of a Paramedic who worked for the local ambulance service; experienced guy. I don't recall the reason I was listening to his daughter's heart one day but I heard a definite regular irregularity. I told her dad about it who came over and also listened and identified exactly what I was hearing...took her to MD, didn't hear anything, Dad insisted on EKG, nothing...go figure...

[OldDude]

3 minutes ago, Wuzzie said:

But what would be the fun in that? Now the parents think the PCP is super smart and the nurse doesn't know what she's doing. ?

HAHA, you nailed it. The MD offices revel in in this practice!!