Heart Murmur

A heart murmur is a category of heart sounds, which are produced by vibrations within the hear chambers or in the major arteries from the back-and-forth flow of blood. Murmurs are classified as: Innocent: No anatomic or physiologic abnormality exists. Functional: No anatomic cardiac defect exists, but a physiologic abnormality (such as, anemia) is present. Organic: A cardiac defect with or without a physiologic abnormality exists. The description and classification of murmurs are skills that require considerable practice and training. In general, recognize murmurs as distinct swishing sounds that occur in addition to the normal hear sounds, and record the (1) location, or the area of the heart in which the murmur is heard best; (2) time of the occurrence of the murmur within the S1-S2 cycle; (3) intensity (evaluate in relationship to the child’s position); and (4) loudness. The subject measures used to grade the loudness or intensity of a murmur. Grade I: Very faint; often not heard if child sits up; Grade II: Usually readily heard; slightly louder than grade I; audible in all positions; Grade III: Loud, but not accompanied by a thrill; Grade IV: Loud, accompanied by a thrill; Grade V: Loud enough to be heard with a stethoscope barely touching the chest; accompanied by a thrill; and Grade VI: Loud enough to be heard with the stethoscope not touching the chest; often heard with the human ear close to the chest; accompanied by a thrill.   References Hockenberry, M. J. (2018). Communication and physical assessment of the child and family. In S. E. Perry, D. Leonard Lowdermilk, K. Cashion, K. Rhodes Alden, E. F. Olshansky (Assoc. Ed.), M. J. Hockenberry, D. Wilson, & C. C. Rodgers, Maternal child nursing care (6th ed.), (pp. 741-792). St. Louis, MO: Elsevier, Inc.