(March 3, 2009 - Insidermedicine) At the American Heart Association Scientific Sessions in New Orleans, we spoke with Dr. Dianne Atkins, Professor of Pediatrics in the Division of Cardiology at the University of Iowa Children's Hospital.
If I had a newborn with a heart murmur...
Dr. Atkins: For a newborn who has a heart murmur, that's a little bit more concerning than an older child. And the chances of that infant having congenital heart disease are a bit higher. So, very likely, at some point a pediatric cardiologist may be called in to evaluate the baby.
What does the evaluation consist of?
Dr. Atkins: For a newborn infant, the history is really going to concentrate on the pregnancy, how the baby did immediately after birth, and how the baby is doing in the first 24-72 hours. But a very important part of the history will be the family history. Are there heart problems in other children in the family, in particular.
What is the difference between a functional and pathologic murmur?
Dr. Atkins: A functional murmur is one that can be heard in a lot of infants and children. It's the sound of blood moving through the heart--but it's a normal sound. A pathologic murmur is an abnormal sound that indicates to the cardiologist that there is something wrong with the heart and typically something wrong with the structure of the heart.
What causes a heart murmur?
Dr. Atkins: The physiologic factors that contribute to a heart murmur--the causes of the heart murmur--can be the velocity of blood as it moves through the heart. If you think of water through a hose, and if you make the hole very small, it tends to create a louder noise. And that's exactly the same thing that happens in the heart. Blood has to pass through a narrow area and it may create a noise. That's what we hear often with a pathologic heart murmur.
What are the main causes of congenital heart disease?
Dr. Atkins: Congenital heart disease is a broad term that we use typically if the structure of the heart is abnormal. That will be present at birth. It may not be protected immediately, but it will be present. The causes of that are quite broad. There clearly is a genetic, or inherited, component--but frequently we really don't, or can't, pinpoint a specific cause for congenital heart disease.
How is congenital heart disease managed?
Dr. Atkins: Congenital heart disease encompasses a large number of specific birth defects within the heart. So the therapy that we would employ depends very much on the specific diagnosis. There can be problems with valves, there can be problems with the walls that separate the chambers and there can be problems with the size of the chambers themselves. The two common therapies that we use are medications, often to help the function of a heart and then very often, surgical repair is required. At some time, sometimes in the newborn period, it can be postponed for several months.
Are there any recommendations for secondary prevention?
Dr. Atkins: Secondary prevention actually begins before the mother becomes pregnant and then continues on during the early months of the pregnancy. It's very important for the mother to try and avoid some certain potential substances, things like alcohol (which we know is related to congenital heart disease). There's an increase incidence of birth defects when the mother is smoking. We always caution mothers to talk to their physicians about certain drugs that she might take during pregnancy. A good diet is probably very good, especially supplementation with the vitamin called Folate.
Dr. Atkins: If my newborn had a murmur, I would expect that a pediatric cardiologist would be asked to evaluate the infant. Certain tests would be obtained that would include: chest x ray, electrocardiogram, and an echocardiogram (an ultrasound of the heart). And then a very specific diagnosis, in terms of the possible potential birth defect that is present. And then I would expect, obviously, a very thorough explanation about the specifics of that defect--what I can expect in terms of the baby's behavior and what I can expect of subsequent treatment.
Sometimes, newborns can have a murmur and it does not imply serious heart disease. And sometimes it can go away with time. It's not always something that is serious.