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A study carried out in our country involving children older than 1 year highlighted the fact that approximately 3% of all cases of systolic murmur addressed to the pediatric cardiology department were organic in nature and required additional investigations to identify the cause. The rest of the systolic murmurs identified through auscultation during the pediatric clinical examination were of a physiological nature, produced by the blood flow at the level of the aortic and pulmonary valves during cardiac contractions.
In adults, the systolic murmur can be manifested in the context of pathologies that include bacterial endocarditis, valvulopathies of various etiologies, heart failure, myocardial infarction, arterial hypertension, anemia and rheumatic fever, but this manifestation can also be caused by the physiological aging processes of the cardiovascular system or the pregnancy period.
What is a systolic murmur?
The systolic murmur is the most frequent manifestation encountered in the pediatric cardiology department. Systolic heart murmurs can be of an organic nature and appear in the evolution of a heart and functional pathology, which manifests itself physiologically. The identification and evaluation of systolic murmurs is the main exclusion feature of congenital heart malformations, which currently reach an incidence of between 0.8 and 1% in the pediatric population.
Systolic murmurs appear as a result of the turbulent movement of blood in the heart cavities and large blood vessels. The intensity of the systolic murmur is determined both by the diameter of the valves and by the speed of blood movement through them.
Depending on the mechanisms that generate its appearance, the systolic murmur may indicate the existence of an obstruction at the level of the ejection tract of the right ventricle (pulmonary stenosis), peripheral type pulmonary stenosis, relative stenosis with right ventricular overload found in atrial septal defects, or they may be benign type without pathological significance.
Systolic murmur symptoms children
The clinical manifestations that accompany a pathological systolic murmur depend on the type of underlying heart disease and can be represented by dyspnea (difficult breathing) or polypnea (increased respiratory rate in the absence of physical effort), cyanosis (blue coloration of the extremities and lips), growth failure (the child does not gain weight), feeding difficulties or intolerance to physical exertion.
When it is necessary to contact the cardiologist
In most situations, the systolic murmur that occurs in children over 1 year of age are benign without presenting any pathological significance, but there are also cases in which this manifestation is due to mitral valve stenosis, atrioventricular regurgitation or an atrial/ventricular septal defect . A new systolic murmur after a streptococcal infection (acute pharyngitis with group A beta hemolytic streptococcus), has pathological characteristics or is accompanied by clinical manifestations specific to a cardiovascular disease, requires presentation to a pediatric cardiologist for further investigations.
In infants, the heart murmur accompanied by the refusal of food, a state of heightened irritability of the little one, profuse sweating in the absence of an infectious context or growth deficit, are indications for a cardiological evaluation regardless of age. In older children with systolic murmur, chest pain and cardiac syncope (loss of consciousness) are considered important symptoms.
Symptoms of systolic murmur in adults
In adults, organic systolic murmur can be accompanied by a variety of symptoms according to the underlying pathology that causes it:
Cyanosis of the extremities and lips; Turgescence of the veins in the neck; Dyspnoea; Chronic cough in the absence of an infectious context; Sweats; Heart rhythm disturbances felt by the patient in the form of palpitations; Cardiac syncope; Chest pain; Edema, ascites; Hepatomegaly.
Risk factors of systolic murmur
The main risk factors involved in the appearance of this manifestation in children are represented by:
Family history of congenital cardiac malformations; Certain pathologies of pregnant women: diabetes, rubella infection; Administration of certain types of medication during pregnancy; Infection with group A beta hemolytic streptococcus.
In the case of adults, the risk factors that predispose to the occurrence of systolic murmur are represented by chronic pathologies of the cardiovascular system (arterial hypertension), acute myocardial infarction, bacterial endocarditis, hyperthyroidism, lupus, rheumatoid arthritis, the use of intravenous drugs or rheumatic fever.
Causes innocent systolic murmur
In infants and small children, the innocent systolic murmur (without organic significance) can appear in a febrile or anemic context or in conditions of intense physical effort, being quite frequently encountered during the period of accelerated growth and development specific to the adolescent.
Causes of systolic murmur in adults
In adults, systolic murmurs are usually organic and may signal the presence of a specific pathology such as:
Aortic stenosis (narrowing of the aortic valve); Hypertrophic cardiomyopathy (thickening of the muscular walls of the heart); Mitral regurgitation (return of blood back from the left ventricle to the left atrium due to insufficient closing of the valve that ensures circulation at this level); Mitral valve prolapse (mitral valve incompetence); Ventricular septal defect (pathological communication between the right ventricle and the left ventricle); Pulmonary stenosis (narrowing of the pulmonary valve); Tricuspid valve regurgitation (blood returns from the right ventricle to the right atrium during systole); Atrial septal defect (communication between the 2 atria); Septicemia (severe bacterial infection).
Diagnosis of systolic murmur in adults and children
Systolic murmurs are identified by the family doctor or cardiologist through the auscultation performed during the periodic clinical examination of the child and adult. Depending on the presented characteristics, systolic murmurs can be:
Benign type: frequently found in children, of reduced intensity, inconstant (the breath changes its characteristics when changing the position or breathing), of short duration, they are not accompanied by other abnormal heart sounds; Pathological: rough, holosystolic (of long duration extending throughout the cardiac systole), of increased intensity, accompanied by gurgling, clicks or gallops.
In situations where the characteristics of the systolic murmur raise the suspicion of a congenital or acquired heart disease, the doctor recommends performing a series of functional and imaging investigations that may include: EKG, echocardiography, gasometry, chest x-ray and cardiac catheterization.
Systolic murmur treatment
The treatment of the organic systolic murmur is etiological and addresses the underlying pathology that determines the appearance of this manifestation. Congenital heart defects of the child that evolve with the appearance of systolic murmurs are usually treated by the cardiologist surgeon through interventions to reconstruct or replace the incompetent structures of the heart (reduction of septal defects or replacement of affected heart valves). Antibiotics are reserved for pediatric patients in which the heart murmur occurs as a result of a bacterial infection with group A beta hemolytic streptococcus.
In the case of adults with high blood pressure values who have a systolic murmur, the treatment of choice is represented by antihypertensives and those who associate heart rhythm disorders benefit from specific antiarrhythmic and anticoagulant therapy (to prevent the formation of blood clots at cardiac level). Antibiotic therapy and surgical treatments have the same indications for adults as for children.
Autoimmune pathologies with chronic evolution, which associate structural changes at cardiac level, require immunosuppressive and anti-inflammatory treatment to modulate the activity of the immune system and reduce inflammatory lesions. Heart murmurs associated with hyperthyroidism benefit from individualized treatment depending on the clinical characteristics of the patient and the recommendations of the endocrinologist.
The systolic murmur is not an independent disease, the complications that can be associated with this manifestation are due to the underlying organic suffering that is not diagnosed or treated improperly. It is recommended that systolic murmurs be addressed to the cardiologist, regardless of the age at which they occur, in order to detect and treat their organic substrate in time and avoid complications.
2023-10-16 07:46:53
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