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For Valentine’s Day: What The Heart Says

In honor of Valentine’s Day, here’s what two of my young patients shared about what their hearts had to say this past week.

3 year-old:

During one 3 year-old well child check, I was listening to the patient’s chest with my stethoscope. I told her to take big breaths while I listened to her lungs. After listening to her lungs, I told her I was going to listen to her heart. She promptly informed me, “My heart doesn’t know what you’re saying.”

And why would it? It doesn’t have ears after all.

4 year-old:

After listening to the heart of one 4 year-old, he asked if he could listen. I helped him put on my stethoscope and directed him to where to listen. When he finished listening, I asked, “What does it sound like?” (I usually get answers like, “beep, beep” or “thump, thump.”) He answered, “My heart is farting.”

It was a proud moment for mom.

Happy Valentine’s Day. May your day be filled with love and laughter, it’s good for the heart.

VSD: A Common Congenital Heart Defect

A VSD, or ventricular septal defect, is a fancy medical term to describe a hole in the heart that isn’t supposed to be there. VSDs are relatively common and are one of the top 3 causes of heart murmurs that I see in my clinic. While VSDs can be part of other/bigger heart defects, they happen as isolated defects as well. I’m going to address only the isolated problems. Isolated VSDs make up about 20% of all congenital heart defects (which is a huge percentage considering all the possible heart problems). VSDs happen in 2-7% of all live births.

Where exactly is the hole in the heart?

As you probably already know, the heart is a muscle about the size of your fist. It has 4 chambers or compartments. Think of the heart like a box. The upper 2 boxes are “atria” and the lower 2 boxes are “ventricles.” The blood is supposed to flow between the atria and ventricles (through a little one-way valve), essentially up and down in the box analogy. The 2 compartments of atria have a big wall of muscle that separates them and prevents them from sharing blood. Again using the box analogy, it prevents side-to-side flow. The ventricles have a similar wall of muscles between their 2 chambers, preventing the ventricles from communicating. When there is a hole or defect in the wall separating the two ventricles (the lower half of the boxes in the heart), the ventricles can have blood flow back and forth. When the blood goes from ventricle to ventricle (a path it’s not supposed to go), the blood that is flowing the wrong way will usually make a sound or murmur.

Is it something to worry about?

Generally the answer is no. Many VSDs are relatively small and will close up on their own. The VSDs that cause worry are the ones that cause other associated symptoms (e.g., feeling tired, sweating-especially during feeds, poor weight gain, or fast breathing). These other symptoms indicate complications (e.g., congestive heart failure)

How are VSDs diagnosed?

Most of the time, a parent will be made aware of the problem when a pediatrician listens with a stethoscope to a child’s heart and discovers a murmur. The definitive diagnosis is then made by a test called an echocardiogram, or echo (which is essentially an ultrasound of the heart).

How it is treated?

Small VSDs are usually treated with “watchful waiting.” This is medical lingo for “do nothing, but keep an eye on it to make sure things don’t get worse.” Often, small VSDs will close on their own, so nothing needs to be done. Sometimes larger VSDs can lead to congestive heart failure (CHF) and will require medications to manage that. Severe cases (that involve the pulmonary blood flow) will need surgery.

Should I see a cardiologist (heart specialist)?

Simple VSDs that resolve on their own, do not always require the expertise of a specialist. However, if there is anything concerning sounding about the murmur or history that is concerning, it is prudent to seek the care of specialist. Your pediatrician will help guide you on if/when to see a cardiologist.

Will my child need surgery for it?

Most cases of children with VSDs do not need surgery. Only children who have moderate-to-large defects that are causing increased blood flow to the lungs usually require surgery.

Did I do something to cause my baby to have this?

The last thing a mother needs is to hear is that she is responsible for her baby’s birth defect. Mothers are already plagued with enough guilt. However, the truth is, some maternal conditions increase the risk of having a child with a heart defect. Maternal diabetes is a well-recognized risk factor for congenital heart defects. Maternal alcohol consumption has also been linked to babies that have VSDs (specifically, a certain subtype called muscular VSDs).

Are VSDs genetic?

The short answer is yes, sort of. The genetic transmission isn’t a direct line like some conditions, but having a family history of previous congenital heart defects (in either parents or siblings), greatly increases the risk (about 3 times) of subsequent children having congenital heart defects. There are also some genetic conditions that are associated with heart defects (e.g., Down syndrome).

The Innocent Heart Murmur

Hearing your pediatrician say, “Your child has a heart murmur,” can cause instantaneous anxiety. In six simple words your mind envisions heart surgery, failure, and death. It’s amazing how we as parents are programmed to worry whenever we hear that something could be wrong with our child’s heart. The most common heart scenario in childhood is that of the Still’s murmur.

There are tons of terms all used to describe the same type of murmur: stills, physiologic, benign, flow, vibratory, innocent, and functional. Don’t be thrown off if different doctors or people call them different things. They are all the same murmur. For ease, I’ll call them Still’s murmurs.

What are Still’s murmurs?

A murmur is nothing more than a sound heard between the first and second beat of the heart. Normally, there is no sound between the two beats. A Still’s murmur is just one type of murmur. However, if your kid is going to have a murmur, this is the one you want because they are completely benign heart murmurs. They are not associated with any heart disease or disorder. They are very common in childhood (with some sources quoting as many as 1 in 3 children having them at some point). They peak in the 2-7 year-old range, but can happen outside of those ages.

How are Still’s murmurs diagnosed?

Still’s murmurs are diagnosed by an experienced doctor listening with a stethoscope (the term is auscultation). All pediatricians should be well versed in diagnosing Still’s murmurs. The diagnosis does not require fancy electrocardiograms (ECG or EKG) or echocardiograms (echo)–that just causes unnecessary worry and cost. A child with a Still’s murmur shouldn’t need to see a pediatric cardiologist (or heart specialist) either as there isn’t anything wrong with the heart. The sound of the murmur is vibratory or musical in nature. A referral to a specialist or further testing would only be indicated if the sound was atypical in some manner and there was need to rule out something more serious. It is worth noting these benign murmurs are heard more often when kids are going through periods of rapid growth or are sick.

How are Still’s murmurs treated?

Because stills murmurs are nothing more than the heart making a reverberating sound when it is pumping the blood, and there is nothing wrong, there is no need for treatment. There are no medications, no limitations on activities, and no need to worry. The murmur will go away on its own with time (usually by mid-adolescence, if not sooner).

So the next time your doctor says your child has a heart murmur, take a deep breath. There is a good chance that it is no big deal.