Why are heart murmurs heard in a newborn? Have you discovered a heart murmur in your child? - no reason to panic Heart murmurs in newborns per month

The heart contracts continuously and rhythmically, resulting in a characteristic “knock-knock” sound when heard with a stethoscope. In this case, the doctor will not hear anything between beats, when listening to the heart. But sometimes, as the heart pumps, an additional sound or sounds called a heart murmur occurs.

Where do such noises come from? Do they indicate health problems? It is important for parents to understand what a heart murmur is in infants, what causes it, and when they should be concerned about a heart murmur.

Table of contents:

Heart murmurs are abnormal sound phenomena that occur between the “knock” and “knock” sounds of the beating heart.

The heart has four chambers: the upper ones are two atria (left and right) and the lower ones are the ventricles (also left and right). Blood from the vessels enters the heart through the atria and is pumped out of the heart through the ventricles.

What do heart murmurs sound like?

As the atria pump blood through the valves into the ventricles, the first sound "knock" is produced, also called S1. As the heart drains blood from the ventricles (and ultimately from the heart itself), a second sound, "knock" or S2, is created. The pause between S1 and S2 (“knock”-“knock”) is called systole, and the pause between S2 and S1 is called diastole. Usually these pauses are completely silent, silent. But sometimes the doctor can hear noise ranging from weak, barely perceptible to rough and pronounced.

Heart murmur can be of three types:

systolic heart murmur (occurs when the heart contracts)
diastolic heart murmur (formed when the heart is at rest).
Continuous (systole-diastolic) murmur. Specific noise, which occurs over both heartbeats.

According to their origin, heart murmurs are divided into:

Organic caused by defects of the heart or its blood vessels, dangerous to health.
Functional, caused by growth processes, characteristics of age or the structure of the heart, are not dangerous for children.

Heart murmurs are heard by the doctor's ear as whistling, blowing, or rough, grinding sounds between heartbeats. Unlike the normal sound of contractions (knock-knock), a heart murmur is significantly different: it usually has a higher or lower frequency.

Heart murmurs can also be pronounced enough to make even the normal sounds of chamber contraction (“knock”-“knock”) unidentifiable in their stream, making it difficult to determine when the first “knock” ended, when the second “knock” began, and what phase the anomalous noise itself belongs to.

Are heart murmurs unusual in infants?

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According to the American Academy of Pediatrics, heart murmurs are quite common and generally not considered abnormal. This means that heart murmurs heard by doctors do not necessarily indicate health problems in children.

Newborns and toddlers early age mostly have "innocent" or functional heart murmurs, which are common occurrence throughout childhood. They are associated with the characteristics of the structure and growth of the child’s heart and blood vessels. These heart murmurs are not dangerous because they occur due to completely normal, regular contractions of the heart muscle, heart valves, or due to the active flow of blood inside the heart.

Heart murmurs in a child under one year old: what does it mean?

Newborns or toddlers with a functional heart murmur are considered healthy children and do not require medical attention.

About 85% of infants have a functional heart murmur, which resolves as children grow and their hearts and blood vessels develop into adult-like structures.

Other causes of functional murmurs include:

Infectious diseases
fever
low red blood cell count ()
activity suppression thyroid gland ().

Sometimes heart murmurs are not completely harmless; they may indicate developmental abnormalities or acquired heart problems. We will give the most common reasons organic heart murmur in newborns and children of the first three years of life:

Stenosis : this is a narrowing blood vessel or a valve that interferes with the normal flow of blood in the heart. The type and name of stenosis that affects the child’s health and blood circulation depends on the location of its occurrence. For example, pulmonary stenosis occurs when a certain space in the pulmonary artery narrows. Other types of stenosis are (a vessel that carries blood into the systemic circle and feeds the entire body of the child) and subaortic stenosis (a narrowing in the area of the aortic valve, before exiting into the aorta itself).
: Experts say about 1 in 100 babies today are born with a structural heart defect or multiple structural abnormalities. A common heart defect in children is ventricular septal defect. This is an abnormal opening in the ventricular septum, which is a layer connective tissue, separating the right ventricle from the left. Another defect is the defect interatrial septum, separating the two atria.
Valve insufficiency : with this condition, the heart valves do not close and do not close together completely. This creates a hole between them and causes a small amount of blood to leak back, which can cause complications, including a heart murmur. Examples of valve insufficiency problems include damage to the tricuspid valve (leaving a hole between the right atrium and ventricle) and mitral valve(hole in the valve between the left atrium and ventricle).

The heart is a very complex organ, and several factors combined can lead to a heart murmur. Ultimately, the type of heart murmur will help your doctor determine the underlying problem. Although parents naturally cannot diagnose murmurs themselves, as doctors do, they can monitor the dynamics of the child’s heart murmur symptoms by asking the doctor questions about the changes he hears.

Symptoms of dangerous heart murmurs in babies

Symptoms of a dangerous heart murmur in infants include:

Symptoms of a heart murmur usually overlap with other conditions. For this reason, it is important to immediately consult a doctor for examination and clarification for an accurate diagnosis.

How are heart murmurs diagnosed in infants?

Used to make a diagnosis in children diagnostic methods and tools that help in identifying the underlying problem causing the heart murmur:

Treatment for abnormal heart murmurs depends on what causes them.

Treatment methods for heart murmurs

Treatment for a heart murmur may vary depending on the cause, severity of the condition, and the age of the child. Some conditions that cause a heart murmur may go away on their own as the child gets older. Other conditions may be chronic but do not pose a risk to the baby.

In any case, the doctor must monitor the dynamics of the heart murmur to ensure the safety of the child.

If cardiac murmur is the result of defects of the heart or its vessels, in addition to murmurs there are severe symptoms mentioned earlier, then it becomes necessary operation. Usually only birth defects heart disease requires invasive treatment procedures as well as medications.

Is there a way to prevent heart murmurs?

It is impossible to prevent heart murmurs caused by congenital heart defects, which are one of the common causes of their provocation. The best way to minimize the risk of a heart murmur is to have your baby examined by a trusted doctor as soon as parents see signs of possible heart defects and abnormalities.

Often, a heart murmur will be detected during a routine examination of the child. Early detection and treatment of heart defects will help normalize the child’s condition.

After birth, every child is exposed initial examination by neonatologists. Sometimes when listening heart rate The baby's doctor can note extraneous sounds between tones. Murmurs in the heart of a newborn may indicate both a serious pathology in this organ and individual characteristics of the body that have virtually no effect on the baby’s health.

Causes of the disease

Doctor Komarovsky believes that heart murmurs in infants can occur due to various reasons, but for the most part they are not dangerous. However, during the first month of life, the baby still needs to be examined. What can cause a heart murmur:

In a newborn baby, restructuring of the circulatory system is the most common cause of extraneous sounds in the heart. This phenomenon It is temporary and usually disappears by 1-2 months. The fact is that the blood circulation of the fetus and the baby are significantly different; for the first time weeks after birth, the blood flow is restructured, because of this noise may occur.
The presence of mild pathologies in development can affect the structural features of the heart structures. Typically, such features do not interfere with its normal functioning, and the resulting heart murmur may disappear over time.
Infection with the scarlet fever or tonsillitis virus (in utero or after birth) can cause an inflammatory process in the body, which leads to disturbances in the functioning and structure of the heart valves.
High loads due to anemia. After successful treatment heart sounds usually return to normal.
Congenital heart defect. IN in this case small murmurs in the heart of a newborn occur when a malformed organ contracts. Komarovsky argues that often this pathology can be diagnosed during intrauterine development fetus or for the first time weeks after birth, because this disease there are a number of characteristic symptoms.

Types of murmurs or what does a murmur in a baby’s heart mean?

It is customary to distinguish two types of noise in newborns:

Functional(or "innocent"). Such heart murmurs do not at all affect the health of the infant and do not require additional treatment. They usually arise for two reasons:

if a doctor uses ultrasound diagnostics to detect an “open” heart oval window" It usually tends to shrink and close over time. To confirm this, it is recommended to perform an ultrasound of the baby - it is better to do it between the ages of 6 and 12 months. When the oval window is closed, the noise also disappears.
an additional chord abnormally located in the heart. This is a very common phenomenon, often hereditary, which does not threaten the life and health of the child at all.

Pathological noises. They are usually accompanied specific signs cardiovascular problems(cyanosis skin and shortness of breath, weak palpation of the pulse in lower limbs). The reason for this may be diseases such as a defect of the interventricular or interatrial septum, various heart defects, an unclosed batal duct, and others.

Diagnostic methods

You need to listen to a heart murmur in newborns almost immediately after birth. And in the first week this must be done regularly so as not to miss pathology. If the doctor listens to extraneous sounds between the tones, then the child is then sent for an electrocardiogram.

Based ECG results, the doctor may prescribe further examination using ultrasound. Ultrasound allows you to “see” all parts of the heart, assess the speed of blood flow and pressure on the walls of blood vessels. This type diagnostics is absolutely safe for the baby.

In particular severe cases it may be necessary to perform a computed tomography or magnetic resonance imaging scan of the heart with the introduction contrast agent or without it. Typically, such a study is carried out in a hospital setting.

Observation and treatment

If a murmur is detected in the heart of a newborn baby, he is observed by a pediatric cardiologist. If the noise carries functional character, then no special treatment is required. It is enough to periodically visit the doctor for examination as the baby grows.
If the heart murmur is of pathological origin, the cardiologist may prescribe medications for the infant such as:

vitamins;
amino acids;
glycosides.

From medical forums: Sometimes, when treating a heart murmur, the child may be shown hormonal drugs. If heart failure is detected, the baby is prescribed diuretics.

Surgery makes sense if conservative treatment doesn't bring positive results, or if the condition worsens. The complexity of the operation depends on the severity of the pathology and the age of the child.

For children under one year of age, surgical intervention is prescribed in exceptional cases when their life depends on it. On post-operative recovery and rehabilitation usually takes about two years.

U healthy person At any age, when the heart muscle works, two tones should be heard:

diastolic, accompanying the phase of relaxation and filling of the ventricles with blood;
systolic, corresponding to the moment of contraction of the heart muscle and the ejection of blood into the systemic circulation.

Extraneous sounds heard in the pause between tones are called noise; they do not correspond to the characteristics normal operation heart, drowning out its tones.

The period when a child is called a newborn (neonatal) is calculated at four weeks from the moment of birth. Pediatric neonatologists often hear heart murmurs in a newborn baby as early as maternity ward. Such news discourages young mothers and causes them anxiety and insomnia. There is certainly cause for concern, since the origin of the noise needs to be clarified, as it may indicate the presence of a serious pathology. This is exactly the case when vigilance will not be excessive. Find out after thorough examination that everything is in order is much more pleasant than missing time and the chance to restore the child’s health.

ICD-10 code

R01 Heart murmurs and other cardiac sounds

Epidemiology

Morbidity statistics show that different variants minor cardiac anomalies occur among 2.2-10% of the population.

Congenital anatomical anomalies of the heart make up a third of all developmental defects, and the trend towards an increase in the frequency of this pathology is increasing. Approximately 0.7-1.2% of children are born with heart defects, most of them without surgical correction dies. The likelihood of having children with structural abnormalities of the heart and blood vessels in a family that already has a child with such a pathology is slightly higher - about 5%.

Causes of heart murmurs in a newborn

The most important criterion for classifying noise is the cause of its occurrence. In newborn babies, extraneous sounds accompanying the work of the heart may be manifestations of congenital anomalies in the development of the heart muscle (pathological or organic reasons), but can be caused by completely innocent, usually disappearing reasons over time associated with the restructuring and adaptation of the heart to existence in new conditions outside the womb.

Such noises are classified as innocent; they are also called functional or benign. They can occur in absolutely healthy babies and the reasons for their appearance are so-called minor structural anomalies of the muscular and valvular apparatus, which do not cause gross disturbances of blood flow:

tendon thread-like formations (ectopic trabeculae or false chords) in the left ventricle of the heart;
open oval window;
long eustachian valve and others.

A number of disorders related to minor anomalies disappear with age, since they are fragments of the embryonic blood circulation. Even if they remain, they often do not have a significant effect on the quality of cardiac activity. For example, valve prolapse, more often the mitral valve, less often the tricuspid valve, also in most cases refers to minor anomalies and is often diagnosed completely by accident. Severe degrees of this pathology (extremely rare) lead to blood flow disturbances and require surgical intervention.

The causes of functional murmurs may not be directly related to cardiac pathologies. The presence of perinatal infections and anemia increases the load on the heart, and the child hears murmurs that disappear after such causes are eliminated.

Most systolic murmurs are considered benign or harmless murmurs.

Extraneous sounds that are constant in nature and heard throughout the entire systolic phase, appearing in the diastolic phase of the heart muscle, as well as late systolic sounds are considered dangerous. They are caused by malformations of the heart muscle, leading to severe disturbances in blood flow, which inevitably entails oxygen starvation others internal organs and tissues, shortage of necessary nutrients. There are developmental anomalies that are incompatible with life.

The most common causes of pathological or dangerous murmurs heard during heart activity are congenital (for acquired defects the child is still too small) anatomical deviations from the norm:

severe valvular abnormalities: mitral prolapse and stenosis, combined defect, tricuspid valve prolapse;
defects of the septa separating the atria or ventricles of the heart;
severe degrees vascular malformations, for example, segmental narrowing (coarctation) of the aorta, open (after reaching one year of age) Botallus duct;
combined anomalies – lesions of two, three, four (tetralogy of Fallot) structural elements hearts;
violation of position (transposition) great vessels;
abnormal drainage (partial or complete) of the pulmonary veins.

Risk factors

Risk factors for congenital anatomical anomalies of the heart and great vessels are quite numerous. A negative role can be played by heredity, pathological pregnancy, in particular, infectious and chronic diseases future mother, drug therapy during pregnancy, miscarriage and long-term infertility and related treatment, taking over-the-counter medications and vitamins during pregnancy. It is impossible not to take into account the influence of the unfavorable environmental situation in the place of permanent residence of a pregnant woman, as well as her addiction to bad habits. The risk group also includes women giving birth over 35 years of age. A serious factor, which increases the likelihood of a heart murmur in a baby is delivery with Caesarean section.

Pathogenesis

The pathogenesis of extraneous noise during the operation of the main muscular organ is associated with changes in intracardiac pressure and blood flow rate in the great vessels, its turbulence, which is often provoked by loose valves, defects in the septa or blood vessels. Benign murmurs, as a rule, predominantly appear in the systolic phase of cardiac muscle activity with increasing blood flow through semilunar valves(usually aortic), anatomically quite normal. Unlike dangerous noises generated by structural abnormalities of the heart valves, chambers or main vessels, safe ones are caused only by blood flow.

A heart murmur is heard in approximately every third newborn, however, it does not always indicate the presence of a disease. The likelihood that an infant's heart murmur is benign nature almost equal to the fact that it is a symptom of congenital cardiac pathology.

Symptoms of a heart murmur in a newborn

There are no rules without exceptions, however, diastolic murmurs are a reflection of heart disease. Noises that are heard constantly - too.

Systolic heart murmur in a newborn is not so unambiguously interpreted. Most early systolic murmurs are functional; however, pansystolic murmurs, heard throughout the entire systolic phase without a pause between the heart sound and the murmur, are also classified as dangerous. Such noises indicate the development of valve insufficiency and reverse flow of blood from the ventricle into the atrium or non-closure of the interventricular septum. Depending on the size of the opening between the left and right ventricles, this pathology is expressed by oxygen deficiency, and the child develops shortness of breath.

Systolic murmurs may also indicate narrowing of the aortic or pulmonary artery.

Minor anomalies in the development of the heart are manifested when listening to periodic systolic clicks.

The diastolic type of murmur occurs mainly with anomalies of the semilunar valves, which ensure the direction of blood flow from the ventricles to the aorta and pulmonary artery, as well as with mitral narrowing. The murmur when the diameter of the mouth of the aorta or pulmonary artery narrows is usually systolic in nature.

The first signs of severe congenital anomalies are mainly detected during prenatal examination or almost immediately after birth. Experienced obstetricians, having accepted the child, notice that not everything is all right with him. The child is weak, with poor appetite, often regurgitates, the skin of the hands and feet is pale bluish in color, blueness is observed above the upper sponge, at the nail bed and respiratory distress. When listening, pronounced noises, disturbances in heart rhythm and heart rate are revealed. Blood pressure readings also deviate from the norm.

More minor (small malformations) are often detected much later, but they also have a lesser extent or do not affect work at all of cardio-vascular system. A slight heart murmur in a newborn in the absence of other symptoms most likely indicates that the body is restructuring and adapting to new conditions of autonomous existence. Such noises usually disappear during the first year of life and there is no danger to further development the baby is not represented.

The ductus arteriosus, which is open until a certain time, connecting the aorta to the pulmonary artery, normally closes one and a half to two weeks after birth, but even for a child aged two to three months, this is acceptable. However, in children older than three months of age, this is already a pathology. The same applies to other aspects of restructuring the cardiovascular system.

The foramen ovale in the septum between the atria usually closes during the first month of a child's life. In some cases, it may close by the time the child reaches one year of age, but this will not affect hemodynamics. The child is healthy, developing normally, he is just monitored by a pediatric cardiologist from time to time.

Ductus venosus – communication with the umbilical cord central system veins and venules of the fetus are blocked in the newborn child during the first or second hour of life, in some cases more time passes or the ductus venosus remains.

Therefore, if after acceptable time limits abnormalities in the structure of the heart do not disappear, they are classified as defects and treated depending on the effect on the functioning of the cardiovascular system.

A heart murmur in a newborn after a Caesarean section is a fairly common phenomenon. This operation is performed only according to strict indications, saving the life of the newborn and his mother. At the same time, the process of natural childbirth and the launch of the mechanisms of the child’s autonomous existence outside the mother’s womb are disrupted. Nature has provided that during the natural process of birth, a child works hard, while adaptive restructuring occurs. Surgically, it is removed in a compressed position of the body and measures are taken to artificially trigger the mechanisms of vital activity. An entire vital cycle is missing from the process - the expansion of the lungs, the first breath, screaming, and the circulation of fluids are disrupted. The risk of children with developmental defects, including cardiovascular ones, appearing in this way is much higher than with natural delivery, since the very performance of a Caesarean section indicates the presence of serious deviations from the norm and a lack of confidence in successful outcome childbirth naturally.

Complications and consequences

Benign heart murmurs caused by physiological reasons go away on their own and without treatment. Small anatomical congenital structural disorders of the heart muscle and main vessels are often unstable and self-limited with age.

Serious congenital heart defects affecting the pulmonary artery and pulmonary valve, the most complex of which are tetralogy of Fallot and malposition of the main vessels of the heart, require immediate surgical intervention to save the child’s life.

There are quite frequent cases of babies being born with holes in the septa between the atria or ventricles. The severity of this defect directly depends on the size of the hole; with this anomaly, a mixture of arterial and venous blood, as a result of which tissue hypoxia develops. Small holes often heal on their own; if it is necessary to close the hole, surgical help is used.

Often, a timely operation completely restores the child’s health, and he can live a full and healthy life. long life. Non-surgical course of congenital heart defects or untimely correction are fraught with the development secondary immunodeficiency and reduced life expectancy. Most children (approximately 70%) with severe hemodynamic disorders due to abnormal development of the heart muscle die in the first year of life. With timely cardiac surgery, the mortality rate is 10%.

Lost time for surgery also leads to the development of irreversible disorders, in particular, various postoperative complications.

Diagnosis of heart murmurs in a newborn

The very first diagnostic event carried out in the maternity ward. A neonatologist must conduct a visual examination and listen to the baby’s heart sounds. In the presence of extraneous sounds, as well as - additional symptoms(cyanosis, pallor, shortness of breath) may recommend further examination.

The absence of a murmur in the heart of a newborn does not mean that there are no malformations of the heart muscle; however, gross anomalies that require immediate intervention are usually immediately noticeable.

The child will definitely undergo tests, in particular, clinical analysis blood to exclude anemia and possible inflammatory processes. A biochemical blood test can also be informative in some cases.

Instrumental diagnostics to assess the condition of a newborn’s heart include the following methods:

electrocardiography – gives an idea of the main indicators of heart activity (rhythm, heart rate) and allows you to determine the degree of their deviations from the norm;
phonocardiography, with the help of which noises are recorded for their subsequent recognition;
ultrasonography heart (echocardiography) – enough informative method, giving an almost complete picture of the structure of the organ and main vessels, pressure, speed and direction of blood flow;
tomography (magnetic resonance or computer), possibly with the use of contrast, allows you to supplement the data of previous examinations and determine the smallest anomalies and features of the disease.
radiography and angiography, prescribed if necessary
catheterization - is carried out as a diagnostic event, during which it is possible to immediately carry out minimal invasive intervention, for example, to correct a heart valve defect.

Differential diagnosis

Differential diagnosis carried out according to the anamnesis collected as a result of examination and examinations. Minor anomalies in the development of the heart and main vessels are differentiated from the so-called large or serious defects. The main criterion is the degree of danger of the symptom and the determination of further treatment tactics. There is a high probability that the noise will be recognized as non-hazardous and the child will simply be registered at the dispensary pediatric cardiologist.

Treatment of heart murmurs in a newborn

In cases where, after examination, murmurs in the newborn’s heart are found to be benign or caused by minimal structural changes heart muscle (great vessels), the child is not prescribed treatment. It is managed by a local pediatrician, sometimes requiring consultations with a cardiologist. Often the noise goes away on its own. If it turns out that the cause of functional noise is not heart disease, but an inflammatory process caused by intrauterine infection, anemia, rickets, Rhesus conflict, then the detected cause is eliminated, after which the child’s condition returns to normal and the heart murmurs disappear.

If a heart murmur in a newborn is considered pathological, that is, caused by a congenital heart defect, surgical treatment is generally indicated. However, surgical treatment is not always resorted to. If the child's condition is satisfactory, he is active, eats well and is gaining weight, he does not have cyanosis and shortness of breath, he may be prescribed drug therapy.

Reception medicines It is prescribed in the preoperative period, as well as after surgery. In some cases (if the defects are not subject to complete surgical correction) shows long drug therapy. Treatment regimens are individual in each case.

In newborns with congenital heart defects, it is necessary to compensate for heart failure and eliminate stagnation of venous blood. First of all, favorable environmental conditions are created for the baby; he is placed in an incubator or a heated crib.

In mild cases at the initial stages of development of cardiac dysfunction, it is enough to reduce the load on the heart muscle by adjusting the water and electrolyte balance. Additionally, feeding the newborn using a tube is introduced, thereby reducing the effort he makes when sucking. At the same time, oxygen therapy is prescribed with regular monitoring of blood gas levels.

At any stage, medications that activate metabolic processes and muscle nutrition of the myocardium are indicated. These are enzymatic preparations that are usually well tolerated. The interaction with cardiac glycosides, antianginal and inotropic drugs, which are also included in the treatment regimen, is positive. The baby may be prescribed:

Cocarboxylase (a single daily dose is calculated individually at 10 mg/kg body weight) – normalizes heart rhythm and prevents blood acidification, the development of hypoxic encephalopathy, pneumonia, restoring blood circulation. Potentiates the effect of cardiac glycosides and improves their tolerability.
Riboxin, which activates redox processes in the heart muscle, its nutrition, normalizes heart rate and blood circulation in coronary vessels. It should be noted that the drug can occasionally increase the concentration uric acid in blood serum.
Panangin normalizes heart rhythm, the disorder of which is caused by potassium deficiency (not recommended for hyperkalemia), improves oxygen absorption and reduces hypoxia of the heart muscle. There is insufficient experience with this drug in children, but it is sometimes prescribed.
Cytochrome C – improves cellular respiration, eliminates myocardial hypoxia and restores its trophism (dosage 10 mg per injection).

Infants with heart defects are also prescribed diuretics to eliminate excess fluid and reduce the load on the heart muscle. Their administration is especially effective when symptoms of interstitial pulmonary edema are observed.

For long courses of therapy, thiazides (Chlorothiazide, Cyclomethiazide), Veroshpiron are used, dosing 1-3 mg per day per kilogram of the child’s weight. Triamterene can be prescribed if there is a threat of potassium deficiency - dosed at 0.3 mg per kilogram of weight. Administration is usually oral. If necessary urgent help– perform one-time intravenous injection Furosemide, the dose is determined at the rate of 1-3 mg per kilogram of the baby’s weight, in severe cases it is increased to 8-10 mg/kg, the use of this drug is fraught with the opening of the Botallocan duct, which is explained by the potentiation of the effect of prostaglandins. Each time the prescriptions are individual, a combination of diuretics with dosage adjustment is possible.

Medicines used to treat newborns with heart defects must restore and maintain normal heart rhythm and heart rate. Cardiac glycosides are used for this purpose and are taken in long courses. Treatment begins by saturating the newborn’s body with Digoxin for a day or a day and a half. The drug is most often administered intravenously, the dosage is calculated according to the formula 0.03-0.04 mg of Digoxin per kilogram of the infant’s weight. For the first time, half the calculated dose is administered. Then twice, maintaining an interval of eight to 12 hours, another quarter of the dose is administered. Then they switch to maintenance therapy - an eighth of the dose is administered every 12 hours. During the entire course of treatment with the drug, regular monitoring of the child’s pulse rate is necessary, since in newborns toxic effects drugs occur very quickly. When the pulse rate decreases, the time interval between drug administrations during maintenance therapy is increased.

The appearance of signs of intoxication is facilitated by: oxygen starvation of tissues, calcium deficiency, blood acidification. When introducing Indomethacin into the treatment regimen (to suppress the autoimmune process), the dosage of Digoxin is halved to avoid intoxication. The toxic effect of this drug is manifested by refusal to eat, frequent regurgitation, vomiting, and deterioration of the general condition.

To relieve symptoms of intoxication, Unithiol, Lidocaine or Difenin are prescribed in antiarrhythmic doses.

If there is no response to therapy with cardiac glycosides, they may initial stage heart failure, prescribe monotherapy with drugs that inhibit the enzymatic activity of exopeptidase (Capoten or Captopril). Dosage the drug individually, making sure not to reduce arterial pressure in an infant, based on daily dose: 1-4 mg per kilogram of his weight, which is divided into two to four injections.

In the second stage of cardiac ACE inhibitors are prescribed simultaneously with diuretics; in the third case, treatment is carried out against the background of Digoxin.

Stimulation of myocardial contractility is carried out with cardiotonics of non-glycoside origin (Dobutamine, Dopamine), which dilate blood vessels, increase the contractility of the heart muscle and systolic blood volume. In critical condition in the absence of heartbeats, Amrinon is used. Medicines in this group are used exclusively with careful monitoring of heart activity, correction of metabolic disorders, dysfunction external respiration and gas exchange.

To prevent the development of endocarditis, newborns are prescribed antibacterial drugs.

Vitamin therapy is recommended for children with heart murmurs: B vitamins - improve metabolic processes and trophism of the heart muscle, ascorbic acid Helps improve immunity and has antioxidant properties. Vitamins A and E will not be superfluous to prevent complications. The doctor may prescribe a course of vitamins or a vitamin-mineral complex, depending on the results of the child’s examination. Breastfeeding and good nutrition mothers are the best vitamin therapy for a newborn with a safe heart murmur.

Physiotherapeutic treatment depends on the child’s condition and should be aimed at normalizing the functions of the heart: automatism of the myocardium, its excitability and contractility, improving blood circulation in the systemic and pulmonary circles, oxygen delivery to organs and tissues, especially to the brain, and activation of immune processes.

To prevent hypoxia, the baby can be prescribed baths: sodium chloride (normalization of the sympathetic nervous system), oxygen (oxygen saturation), with carbon dioxide(improves myocardial function, increases resistance to physical activity), iodine-bromine and nitrogen (have calming properties).

Immunostimulating procedures - sun and air baths, inhalations with ginseng, aloe extract and other immunomodulators.

In the presence of foci of chronic infection, local and general ultraviolet irradiation is used.

The procedures are contraindicated in cases of heart failure of the second and third degrees and in cases of complications with endocarditis.

Traditional treatment

Arsenal of recipes traditional medicine for the treatment of heart diseases, including murmurs, is quite extensive. Basically, this is treatment with herbs that have sedative properties and thin the blood. However, the age of the patients we are interested in is too young to risk using decoctions and infusions medicinal herbs orally, but you can add infusions or decoctions of medicinal herbs to the bath. They disinfect the baby's skin and soothe him before bed, strengthen the immune system and give strength. Works well on nervous system pine needles, valerian, lavender, oregano and mint. In pharmacies you can buy herbal bath mixtures, for example, they contain motherwort and string herbs, valerian rhizome, and lemon balm leaves.

Baths with sea salt for bathing children. You can consult your doctor about the possibility and frequency of their use, as well as the salt concentration. The salt is diluted separately in a bowl, and then filtered into the bath through four layers of gauze. You can also add an infusion of some herb (lavender, motherwort, mint).

It must be remembered that herbs can cause such small child allergic reaction. To make a test, you need to moisten a piece of cotton wool in a decoction or infusion of herbs and apply it to the skin on the handle; if redness does not appear after a quarter of an hour, you can bathe.

Decoctions and infusions are prepared at the rate of a handful of herbs per five-liter bath. Pour the herb with a liter of boiling water in an enamel, glass or earthenware container, leave for about an hour, filter well and add to the prepared water. Herbal mixtures are taken in 1:1 proportions, making sure that there is no allergy to the components. Decoctions and infusions for bathing newborns are used only when freshly prepared.

When the doctor places the phonendoscope against the chest, he hears the heart beating (“knock-knock”), in medicine these sounds are called tones. They occur when the heart valves work. The heart pumps blood, and valves are needed to ensure it flows in the right direction. Before the heart contracts, the valves between the atria and ventricles close. This is necessary in order to release blood from the left ventricle into the aorta (to organs and tissues) and from the right ventricle into the pulmonary artery (to the lungs). When this happens, we hear the first tone (or first “knock”). After the heart contracts, there is a pause (relaxation), at which point the semilunar valves located at the exit from the left ventricle into the aorta, as well as from the right ventricle into the pulmonary artery, close so that the heart can fill with blood. When these valves close, we hear a second tone (second “knock”). These are normal heart sounds. If for any reason an obstacle to smooth, calm blood flow (for example, a narrowing) occurs in the heart or in the region of the heart, a turbulent (vortex) blood flow occurs in this place, and the doctor hears a noise between heart sounds.
Heart murmur can be different: soft, blowing, rough, occurring at the moment of relaxation of the heart or contraction, etc. - depending on the reasons causing it, and there are many of them. But all noises can be divided into two groups: pathological, which are often the first, and sometimes the only symptom congenital heart disease in young children, and innocent ones, which can be heard in absolutely healthy babies. In most cases, an experienced doctor can determine by the nature of the noise whether it is more likely to be pathological or innocent. However, a more accurate answer can only be given by echocardiography (ECHOCG - ultrasound of the heart), in which the doctor sees the structure of the heart and surrounding vessels with his eyes: after all, we are accustomed to trusting them more than our ears. True, these eyes must be experienced, and the apparatus on which the research is performed must be modern. Echocardiography is not mandatory in the first year of a baby’s life. If necessary, the pediatrician will refer you for this examination. In equipped maternity hospitals, in the presence of a heart murmur, echocardiography is performed even on newborn children to exclude congenital heart disease.

Why do heart murmurs occur in infants?

The reasons may vary. Let's look at the main ones.
Congenital heart defect. In case of congenital heart disease, saving the child’s life requires constant monitoring by a pediatrician, consultation with a cardiac surgeon, and resolving the issue of surgical treatment, its timing, selection medicines if necessary. This serious illness, so if the doctor hears heart murmur in infant, it is necessary to exclude this pathology. To do this, first of all you need to do an echocardiogram in a specialized institution. If necessary or in doubt, the pediatrician will refer the child for further examination to a cardiac surgery hospital. If there is no such treatment center in the city where the child lives, then studies can be done (ECHOCG, ECG, X-ray chest in two projections) and ask the pediatrician to send these documents, accompanied by a detailed statement about the baby’s condition and well-being, for consideration by mail to the cardiac surgery hospital.

Restructuring of blood circulation after birth. Heart murmurs in newborns may be a consequence of changes in the circulatory system after birth. During intrauterine development, the blood in the fetus circulates differently than in a child who has already been born. The fetal lungs do not breathe and cannot enrich the blood with oxygen. The blood receives oxygen through the umbilical cord, from the mother. Therefore, in the fetus, the blood, bypassing the lungs, passes through the so-called ductus arteriosus and the open foramen ovale. The ductus arteriosus connects the pulmonary artery (the vessel leading from the heart to the lungs) and the aorta (the vessel leaving the heart and carrying blood to the organs and tissues of the body). And the open foramen ovale is a hole in the septum between the right and left atria of the heart, from which blood enters the left ventricle and again into the aorta. The fetus needs both a patent foramen ovale and a patent ductus arteriosus. When the baby is born, takes its first breath, the lungs expand, and the umbilical cord is clamped and cut. Now the baby provides itself with oxygen, and blood from the right side of the heart enters the lungs, where it is enriched with oxygen, from the lungs - into the left side of the heart and into the aorta. After birth, patent ductus arteriosus and patent oval window stop functioning and close because they are no longer needed.

Heart murmur: patent ductus arteriosus

The patent ductus arteriosus in healthy full-term newborns ceases to function by the end of 1–2 days, less often during the first week of life. In some cases, this process is delayed. Then the doctor can listen heart murmur in infant. As mentioned above, the patent ductus arteriosus connects the aorta and pulmonary artery. The noise arises due to turbulent blood flow in a narrow compared to the aorta and pulmonary artery duct. In such cases, it is necessary to observe a cardiologist and repeat echocardiography at a frequency determined by the doctor. The presence of a patent ductus arteriosus by 3 months of life is considered a congenital heart defect. However, if its size is small, it can close on its own later, usually up to 1 year. Depending on the condition of the child, the size of the duct and the presence or absence of a tendency to close it, the question of surgical treatment may be raised.

Heart murmur: patent foramen ovale

Patent foramen ovale the doctor cannot hear with a phonendoscope, since the pressure difference between the atria is small, and a vortex blood flow cannot be created in this place so strong that the doctor can recognize it. In addition, a patent foramen ovale is an opening between the right and left atria that has a valve. This valve prevents blood from flowing from the left atrium to the right. The open foramen ovale continues to function in 50% of children until the age of 1 year; its closure occurs in most cases until the age of 2–3 years. According to statistics, it is detected in 20–25% of adults. The presence of an open oval window does not in any way affect the growth and development of the child, or his health, and is not considered a congenital heart defect, but a minor developmental anomaly. If in the first months of life, according to echocardiography, a child was found to have patent oval window, there is no need to worry, but you need to consult a pediatric cardiologist, repeat echocardiography at 1 year of age and thereafter, if necessary.

However, in most children, heart murmurs are innocent and are associated with the growth characteristics of the chambers and vessels of the heart or with the peculiarities of its structure, for example, with the presence additional chord in the cavity of the left ventricle, etc.
Let's talk about these noises.

Heart murmurs associated with uneven growth of the chambers and vessels of the heart. Such noises are normal and physiological, but can only be detected by experienced pediatrician, since they are soft in timbre and quiet, are heard at certain points above the area of the heart or blood vessels. In themselves, such noises pose absolutely no threat to the development and health of the child and disappear on their own as he grows. However, it is worth recalling that if a pediatrician hears a heart murmur, in any case it is necessary to find out its nature by doing an echocardiogram in a specialized institution in order to exclude anomalies that require treatment.
Heart murmurs associated with the presence of accessory chordae(falshchord) in the cavity of the left ventricle. These noises are detected quite often and are accompanied by a characteristic noise. Falshchords are fibrous or fibrous-muscular cords (threads) that are located in the left ventricle of the heart, connecting its opposite walls (or muscles called papillary). Due to the fact that the speed of blood movement during contraction of the ventricle is relatively high and the blood “beats” against the chord-string (like a strong wind through wires), a characteristic “squeaking” or “whistling” noise occurs, which the doctor hears. With age, due to the growth of the left ventricular chamber and changes in its shape, the chord can attach to the surface of the heart muscle and, as it were, self-destruct, but this does not always happen. A false chord in the left ventricle is a minor developmental anomaly. There is no need to worry about detecting it in a child, since it does not disrupt the blood flow inside the heart, does not affect its functioning, and does not cause heart failure. The presence of a false chord does not require any restrictions in children (including physical activity). There is a hypothesis that in a small number of patients, false chords may be one of the causes of certain cardiac arrhythmias, but this connection has not yet been proven. When listening to any murmur in the heart, even if it is characteristic of the murmur of an accessory chord in the cavity of the left ventricle, it is necessary to consult a pediatric cardiologist, do an echocardiogram to confirm the diagnosis, and, if necessary, an ECG.
Heart murmur: diseases not related to the heart itself. Heart murmurs in infants can occur with severe anemia (a group of diseases characterized by a decrease in the content of hemoglobin (a substance in the blood that carries oxygen) in erythrocytes (red blood cells) or the number of red blood cells per unit volume of blood in a person of a given sex and age), if the thyroid function is disrupted glands, rickets, high temperature etc. In this case, the doctor’s task is to identify this pathology, relying on one of its additional symptoms - a heart murmur, to rule out disease of the heart itself and carry out appropriate treatment. Thus, heart murmurs are murmurs that always have a cause related to the structure and size of the heart, its structure and blood circulation inside the heart, its speed and viscosity. In most cases, noises in children are innocent. But we should not forget about such a serious pathology as congenital heart defects, which require immediate action from parents and doctors. To be calm and not worry about the health of the child if there is heart murmur, it is necessary to do echocardiography - a safe and very informative research method.

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Moms and dads are usually very scared when they hear from the doctor that their child has a heart murmur. In a panic, they begin to look for more detailed information about this phenomenon, but such a “find” by a doctor does not always indicate serious pathologies cardiac activity. The famous pediatrician Evgeny Komarovsky talks about where these noises can come from and what they mean.

About the problem

Heart murmurs are not a diagnosis, says Evgeny Komarovsky. It's just a symptom. Of course, parents should not leave him without attention, but they should not fall into a panic mood either.

The fact is that noises are different. Most often, when doctors say that a baby has a noise, they mean physiological noises. They are not dangerous and do not require any special treatment, do not interfere with living a normal active life, and in general are a reason for worries - by the end of puberty, they mostly pass without a trace.

But there are other noises - organic ones. They are associated with anatomical abnormalities in the development of the heart and require constant monitoring, and, if necessary, treatment, including surgery.

The doctor will hear a functional murmur (systolic) when there are slight changes in the heart cavity or its valves. Most often they are found in children who are subject to frequent viral diseases, as well as children with a narrow chest inherited from relatives.

This noise is practically invisible on an ECG; it can only be seen on an ultrasound of the heart. More dangerous noise diastolic (organic) is detected in all types of studies.

Causes

There can be many reasons that cause an extraneous acoustic effect when listening to a heartbeat, not all of them are dangerous:

Regurgitation. E This word denotes the process of incomplete closing of the valve. Blood begins to flow back through the remaining lumen. This movement causes the noise that the doctor hears through a phonendoscope. Komarovsky advises not to consider regurgitation a disease, since it does not require any treatment. This congenital feature structure of the heart, this occurs often, and equally often the gap closes on its own with age.
Vasoconstriction. Stenosis may be due to physiological changes, which occur in an intensively growing organism, and can be caused by congenital defects.
Narrowing of the valves. Sometimes this condition requires immediate surgery to avoid the development of heart failure, and sometimes in cases with physiological narrowing, only observation is sufficient.
Holes in the septum of the heart. The pathological discharge of blood through them causes noise. The causes of the pathology are mainly congenital. In some cases, the hole closes on its own.

Parents' actions

Doctors who are observing the child should think about how to act and what treatment tactics to choose. The task of parents, according to Evgeniy Komarovsky, is not to interfere with them, but to assist them in every possible way. The algorithm of actions is quite simple:

Primary noise detection. This usually happens at a pediatrician's appointment while listening with a phonendoscope. A normal doctor will not make a diagnosis based only on what he hears; he will simply explain what changes he heard and give a referral for examination. Komarovsky advises not to panic and under no circumstances refuse diagnosis. Parents should receive referrals for an ECG, cardiac ultrasound, echocardiographic examination, and sometimes an MRI. After visiting these offices and specialists with the results of measurements and graphs, you need to go to a pediatric cardiologist.
Confirmation of organic noise. If a cardiologist, based on the studies completed, concludes that there is a pathological organic damage hearts, he can appoint drug treatment or surgical intervention. You should follow all the recommendations again, without panic - the modern level of cardiac surgery is at this high level that even embryos in the womb can be successfully operated on. Forecasts are most often very favorable.
Confirmation of functional noise. If the cardiologist says that the noise is not dangerous, you can breathe a sigh of relief, return home and live as before, leaving the child alone. True, it is still advisable to observe a cardiologist for some time, visiting him at least once every six months, to monitor the dynamics - the noise may or may not disappear.
Refuting the noise. And this happens often. Studies show that everything is normal in the child; the cardiologist finds no murmurs during repeated listening. Parents in such a situation do not need to quarrel with the pediatrician who heard the noise for the first time. An examination is never superfluous.