Should I seek the opinion of a cardiologist for my daughter or let it go?

Hello

I was told by my family doctor in 2008 that my youngest daughter has a heart murmur. She was born Sept 28,2005 and currently weighs 34 lbs (5th percentile I believe?) with a height of 41 inches (95-ish percentile). She is sick often and is very skinny (picky eater) but otherwise appears "normal".  The doctor described the heart murmur as "musical" and listened while she was lying down as well as standing up. He said that it "should have changed but it did not" with her position. We went for an echocardiogram and it came back normal. Just last month during her annual check up he again mentioned her heart. We went to a different lab for another echocardiogram (with interpretation by a different physician from the first one). I wondered out loud during her appoitment with the GP if she should be referred to a pediatrician or a cardiologist. What is your take on this? Does this sound like further investigation is warranted or should I accept the results of the echocardiogram? I understand that most heart murmurs cause no problems so I don't want to make mountains out of mole hills but on the other hand I want to make sure my daugher is ok.  Thank you for your time.

[Jeffrey R Boris, M.D.]

Dear Kelly,
This is an interesting situation that I have noticed in some of my patients.  As you may have heard, 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, or innocent, murmurs.  The murmur that you list as described as “musical” is most likely a “Still’s murmur”, the most common of the six innocent murmurs.  As your cardiologist described, it should have disappeared OR gotten quieter and localized to the left lower sternal border with upright position.  With a normal echocardiogram, assuming that it was done at a pediatric (and not adult) echocardiography laboratory, the murmur is most likely innocent.  In my experience, the Still’s murmur that does not change with upright position is often associated with what is called a left ventricular false tendon.  This is an extra strand of tissue that stretches across the left ventricle.  This strand vibrates like a guitar string, but doesn’t typically cause any problems.  We call this a “normal variant”, meaning it isn’t supposed to be there, but we don’t particularly worry when we see it.

I do not know if your cardiologist (or echo lab) specialized in pediatrics or adult cardiology.  If it was not a pediatric specialist, it would be helpful to make sure that a pediatric cardiologist sees your daughter if there is any question.

[mshanson]

Do you have the results from the second echo? If that one came back fine, then I'd say it's likely fine, and to "try" not to worry about it. But if anything comes back abnormal, I'd see the opinion of a cardiologist. Has she had an EKG done?

[KellyAJoyce]

The results should be at my doctor's office by now but getting the results will be another story. Her appointment is not until Oct and they say they only call back if there is something wrong (not sure if I trust that!). I have her on the doctor cancellation list so hopefully we get in sooner.  

We have not gone for an EKG but during the echo there were leads on her chest and I saw the wave pattern of her heart beat-does that test show the same stuff? I guess I am unsure of the differences between the 2 tests.

[mshanson]

Echo is an ultrasound of her heart, it does measure the heartbeat, but doesn't give the same details as an EKG. With an EKG she will have leads all over her body (several on her chest) as well as leads on her legs normally. EKGs measure heart rate but also the electrical impulses of the heart, which can tell how each of the different chambers are beating (firing) etc...

Echo is more to look at physical detail of the heart, and see how well the parts are functioning, if there are defects etc..

[CHELLETO6DOGS]

I would think your daughter is okay.. my soon to be 7 year old only weighs 41 pound and he was 8 pounds at birth...and he is short for his age as well..
I just wanted to comment on her being sick all of the time.. Chris was also sick all of the time too many times we were in the hospital..I think he had pneumonia 3 or 4 times by the time he was 3. many many battles of croup... finally the pulmonologist referred him to an allergist well to rule out allergies but mainly to seek out him immune system.. blood test were ordered and he was immune compromised.. he needed to have a DTAP and a pneumovax (not sure how to spell the last one) even though he already had all of his shots he needed a booster. what a difference it made..
Good luck with your daughter
Michelle

[KellyAJoyce]

Thank you for your response Dr. Boris. The first echo was performed at a regular medical lab and the second echo was performed at a cardiologist's practice (most likely NOT a pediatric specialist) by one of his technicians.  Is there a big difference in how children's tests are done? (Now I do not know if this matters but I am in Sudbury, Ontario, Canada ).

I have not been seen by a cardiologist. I have only been dealing with this through my general family doctor. Do you think I should ask my GP to refer us to a pediatric cardiologist (if we even have one up here- would a "regular" cardiologist suffice) ?

Thank you
Kelly Joyce

[Jeffrey R Boris, M.D.]

There is absolutely a difference in how echocardiography is performed between adult and pediatric echo laboratories.  There are many things that are looked for in pediatric studies as well as many different physiologies and associations that are well known that are truly unfamiliar in adult labs.  The same is true for the cardiologist--only a pediatric cardiologist is trained in pediatric and congenital heart disease.  Children are not small adults, and their care should not be treated that way, either.