A heart murmur is an extra sound the heart makes when blood is flowing through the heart (National Heart, Lung, Blood Institute [NHLBI], n.d.) Some murmurs are innocent and some can be related to a heart defect (NHLBI, n.d.). Heart murmurs are diagnosis by grades (U.S. National Library of Medicine, 2019). The grades are from 1-6 1-6 being the lowest sound heard and 6-6 being the loudest hear (NHLBI, 2019).
In the scenario presented the NP diagnosed a grade 2 heart murmur. Due to the grading and the presents of no other abnormal findings there would be no need for further investigation. It is vital for the NP to evaluate the family history and any signs and symptoms presented that would indicate further work is necessary (Healthy Children, 2015). History of check pain, dizziness, fainting or shortness of breath would indicate abnormal finding (Healthy Children, 2015). An innocent heart murmur would still need to be continued to be monitored annually to make sure it does not change.
For heart murmurs grade three and greater the proper treatment would be to refer to a pediatric cardiologist (Ritz, 2017). Heart murmurs can be related to congenital heart defects (Huether & McCance, 2017). Heart murmurs can be related to aortic septal defects (ASD) which are most common (Huether & McCance, 2017). Heart Murmurs can also be seen with valve disorders (Ritz, 2017). When a grade 3 or high heart murmur is found performing other tests will become necessary such as electrocardiogram, echocardiogram (Cardio Smart, 2012). A cardiac catheterization or surgery may also need to be performed to correct the defect (Cardio Smart, 2012).
Cardio Smart American College of Cardiology. (2012). Heart murmur topic overview. Retrieved from: https://www.cardiosmart.org/Healthwise/zx14/63/zx1463
Healthy Children. (2015). Sudden cardiac death. What is it? Retrieved from: https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Sudden-Cardiac-Death.aspx
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby
National Heart, Blood, Lung Institute [Nhlbi]. (n.d.). Heart murmur overview. Retrieved from: https://www.nhlbi.nih.gov/health-topics/heart-murmur
Ritz, S.B. (2017). Heart murmurs. What are heart murmurs? Retrieved from: https://kidshealth.org/en/parents/murmurs.html?WT.ac=p-ra#catbody-basics
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