Pediatric Heart Expert Forum
Level 4 pediatric murmur
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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Level 4 pediatric murmur

My 10 year old grandson went for his camp physical and was told he has a level 4 heart murmur.
He was born with a murmur but was told it was a mild functioning murmur.  
He was just at his pediatrician a few weeks ago and nothing was said, all of a sudden a dr hears the murmur before he even begins examing my grandson.  His mother is calling the cardiologist on Monday but I am wondering what a level 4 murmur is and how it can occur so quickly since he last appt.
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773637_tn?1327450515
Dear Gram,

A murmur is the term that is used to describe an extra sound created in the heart.  That sound is created by turbulence.  The turbulence can be either normal or abnormal.  Abnormal turbulence signifies a structural defect of some sort in the heart.  Normal turbulence occurs when normal blood flow through the heart and lungs can be heard.  Approximately 2/3 of all children and adolescents have normal, also called innocent or functional, murmurs.  

We grade the loudness of the murmur on a scale of 1 to 6.  A “2” is as loud as the breath sounds.  A “3” is louder than that.  A “4” and above has so much turbulence that you can not only hear but you can also feel the murmur.  That said, a lot of primary care providers do not understand the finer points of this classification, and often mischaracterize grade 3 murmurs as a 4 because they just think it’s louder.   Although I am not able to examine your grandson, chances are quite good that his murmur is innocent.  Some innocent murmurs become louder with age before disappearing later in adolescence.  It is quite uncommon for a structural cardiac defect to be missed for so long and then create a large amount of turbulent blood flow.
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Hi there, my now 6 1/2 year old had a grade 6/6 murmur when he was born, yes he had to have surgery to correct his issues.
about a year after that he went down to a 1-2/6  soft murmur. he is followed by his cardiologist and does see his primary care doctor. there are times his murmur does get louder, when he is ill, and running. according to his primary and cardiologist there are few other things that can cause the murmur to be louder. it wouldn't hurt to put a call into his cardiologist just to be sure. i know there was a time they heard my sons murmur at a 4/6 and when he ran around the office it and the doctors listened to him again it actually went back to a 2/6
good luck toy our grandson and I hope things are okay
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773637_tn?1327450515
Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
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