By: Dr. Brian Gannon
In honor of the month of love, which is also heart disease awareness month, I would like to review some common fears parents may have about children and heart diseases.
Your big, strapping seventh grader is seeing the pediatrician for a sports physical, and the doctor tells you he has a heart murmur. Suddenly your own heart skips a beat, and you worry about your son’s future in athletics and his general health, with scary visions of open heart surgery in your mind. But should you really be worried?
First, what is a murmur anyway? With each heartbeat, your doctor hears a sound like “lub-dub,” which represents the closing of the valves between the upper and lower chambers of the heart. Any sound other than the typical “lub-dub” would be defined as a murmur.
Most murmurs are “innocent,” meaning the sound is produced by a normal, healthy heart with blood flowing through it correctly. The murmur occurs because there is more flow than usual for some reason, or it is flowing more rapidly. This may happen with a nervous teenager (as in the example above), after exercise, or during a fever. The first evaluation for this type of murmur, especially if discovered by an urgent care doctor or provider that does not know your child well, is for your regular doctor to listen to the child at a time that he is not sick. If the murmur is gone, then it is very likely innocent, requiring no further testing. A murmur that comes and goes is generally not dangerous.
Sometimes the rhythm of the heart is not completely regular. Parents or providers may notice that the beats are not evenly spaced: “lub-dub…lub-dub……..lub—dub…lub-dub.” This can be a problem with the heart’s internal pacemaker, which is a little area within the heart that triggers the beats in rhythm. But most commonly, at least in children between 5 and 15, it is normal variation with breathing. Your pediatrician can tell when the beats are closer as the lungs fill with air, and get further apart when the lungs empty and the heart has more space to beat. This is really true in all of us, but since children are usually healthy and their chest wall is thinner, the variation from beat to beat is easier to hear.
An abnormal rhythm will often cause symptoms in the child, like passing out or feeling like the heart is racing, even when at rest. If these symptoms are noted, it is important to have your child evaluated by her regular pediatrician. Often we will find a simple explanation that does not require surgery, but a full exam and heart tracing is needed in these situations. If there is a family history of heart rhythm disturbances, especially sudden death in a person younger than 50 years old, we really need to be made aware of it, so we can look further.
I would like to take this time to make a special note about the pre-participation sports physical. Any student planning to participate in school-sponsored sports will be required to have a screening physical. It is very important for parents to be aware of this and plan well ahead of the season of the child’s sport. If the physical or evaluation turns up an issue that must be addressed, it could delay your child’s clearance to play or even practice with the team, so it is best to schedule the sports physical a month or so before you need it. And the most important question on the KHSAA form is about the heart: Is there a family member who died suddenly before age 50? I cannot stress enough how vital it is for parents to fill out the questionnaire before bringing the student to the doctor, so we have all the information we need to state clearly that your child may be allowed to play.
The testing is fairly simple, a 12-lead ECG or tracing of the electrical activity of the heart. But getting the ECG interpreted and evaluated may take valuable time, which would be time well spent if it prevents a catastrophe on the basketball court. There are a few rhythm problems that run in families, such as Long QT and Wolff-Parkinson-White syndromes, so if you know about these, definitely let the doctor know.
So be reassured that most of these extra sounds or irregular rhythms in children and teenagers are harmless, but if your child has significant fatigue, chest pain, or passing out, keep your doctor in the loop!