I did not realize how common systolic heart murmurs were in children. I have been fortunate to hear many so far in my pediatric rotation. I have actually found two that were missed by other providers (one in a 2-year-old and another in a 6-month-old – I was super proud of myself those two days!). The one murmur that sticks out for me the most was in a 6-month-old boy. His mother had done methamphetamines throughout her pregnancy and went into preterm labor. The patient was taken from his mother and rights were granted to his grandmother. The patient required continuous pulse oximetry and frequent check-ups. My preceptor had me go in with her on this visit. The grandmother is very protective and did not like new providers (or students) handling her grandson. My preceptor had been recommended to her and was also given a thorough report about the patient prior to the initial visit. She had also seen him about once a week for a couple of months so there was a rapport and trust there. The grandmother did allow me to listen to the patients murmur. I just barely had to lay my stethoscope down to hear it. It was so loud. I’m still learning the grades but assumed this was a grade V/VI easily. My preceptor graded it at a V.
I have learned from my preceptor that most murmurs do not require any special diets, activity restrictions, or any special treatment. She always orders an ECHO to have on the patient’s chart. And of all the pediatric patient’s I have seen and murmurs I have heard this was the first grade V I had heard and I do not think I will forget it. The grandmother reported the patient would be scheduled for surgery some time in the future but the pediatric surgeon in Dallas wanted him to be older. I really love pediatrics more and more as my clinical days go on. This has been a great learning experience, especially for someone who was dreading it so much in the beginning.