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]

19 hours ago, OldDude said:

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

actually...in this case all murmurs are guilty until proven innocent...

[OldDude]

Just now, ruby_jane said:

actually...in this case all murmurs are guilty until proven innocent...

HAHA...good point!!!

[kkbb, BSN, RN]

As a parent, I would want the nurse to call and tell me that she heard a murmur. The kid looked off and you assessed. Sounds to me like you were being a prudent nurse. ?

[bluebonnetrn, BSN, RN]

On 2/21/2019 at 8:21 AM, Amethya said:

Thank you! This is interesting.

Hey Amethya - HAPPY BIRTHDAY!!!!

[offlabel]

On 2/22/2019 at 8:34 AM, OldDude said:

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...

Sound like respiratory sinus arrhythmia. Common in children. Really helpful to palpate the pulse while listening to determine if the "irregularity" is perfusing.

[Amethya]

On 2/22/2019 at 12:13 PM, bluebonnetrn said:

Hey Amethya - HAPPY BIRTHDAY!!!!

Thank you! I didn't think you would know! I am now 28 years old. xD

[nursekoll, BSN, RN]

Thanks everyone for your input and encouragement. Today I received the doctor's report and it did specify that education was provided to the parents regarding the transient nature of benign murmurs. "Heart murmur can come and go especially with a fever or viral illness" (kid was on Tamiflu-never told me!) Also that it would be entered into his history to be reassessed at future physical exams. I felt the report was very thorough and respectful of the collaboration/ sharing of information between school and Primary Care Provider. This is so reassuring!

Lately parents in general seem very annoyed when I call about anything, so it's wearing on me. It's nice to be encouraged and feel respected once in awhile! I know I did the right thing, but worried others wouldn't agree.

[nursekoll, BSN, RN]

On ‎2‎/‎21‎/‎2019 at 1:53 PM, 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!

And I got a DaveyDoo Graphic!!! So cool!