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Previously Diagnosed With Heart Murmur. Having Shortness Of Breath And Chest Pain. Worrisome
Question: My son has a heart murmur. At 3 a paediatric cardiologist determined it was innocent. He had been passing out when he got very mad or hurt himself
. Now he is 14 and had shortness of breath for a year. It's getting much worse. Originally diagnosed with exercise induced asthsma. Now it looks like heart murmur is the real problem. Do heart murmurs get worse? He can no longer play hockey due to chest pain shortness of breath and fatigue. He is having many tests done now. Can an innocent heart murmur change?
. Now he is 14 and had shortness of breath for a year. It's getting much worse. Originally diagnosed with exercise induced asthsma. Now it looks like heart murmur is the real problem. Do heart murmurs get worse? He can no longer play hockey due to chest pain shortness of breath and fatigue. He is having many tests done now. Can an innocent heart murmur change?
Hi,
Thanks for writing in.
I am a qualified and certified cardiologist. I read your mail with diligence.
On reviewed the history of now having shortness of breath (I assume that there is no wheeze or whistling sounds to be diagnosed asthma) with chest pain in a 14 year old boy with a previously diagnosed murmur is a matter of concern. It needs further evaluation. To answer your last question first, whether a murmur diagnosed as innocent at age 3 can change? Answer is part yes. To give an example what might be the issue at age 3, suppose he had a bicuspid aortic valve (a rather common occurrence in general population with very mild systolic murmur : it would have been labelled innocent) now the aortic valve has become diseased, developed narrowing the systolic murmur is no longer can be innocent and it needs evaluation. Similar thing can happen with other valves of heart. My suggestion is to seek an appointment with a cardiologist who will subject your son to echocardiography and issue will be sorted out. Meanwhile no heavy exercises. If there is question, I will be most happy to answer. Good Luck.
With best wishes.
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Thanks for writing in.
I am a qualified and certified cardiologist. I read your mail with diligence.
On reviewed the history of now having shortness of breath (I assume that there is no wheeze or whistling sounds to be diagnosed asthma) with chest pain in a 14 year old boy with a previously diagnosed murmur is a matter of concern. It needs further evaluation. To answer your last question first, whether a murmur diagnosed as innocent at age 3 can change? Answer is part yes. To give an example what might be the issue at age 3, suppose he had a bicuspid aortic valve (a rather common occurrence in general population with very mild systolic murmur : it would have been labelled innocent) now the aortic valve has become diseased, developed narrowing the systolic murmur is no longer can be innocent and it needs evaluation. Similar thing can happen with other valves of heart. My suggestion is to seek an appointment with a cardiologist who will subject your son to echocardiography and issue will be sorted out. Meanwhile no heavy exercises. If there is question, I will be most happy to answer. Good Luck.
With best wishes.
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
XXXXXXX had sharp chest pain last night even though he was just sitting and not doing anything. . Cardiologist office said go to hospital today for echo. He had an EKG done first that said 'probable left ventricular hypertrophy'
The did an echo after that and emerg doctor said it was normal. I did some Internet searches and found that LVH can be exercise induced. He has all the symptoms on the list; chest pain, shortness of breath, fatigue and dizziness when he exherts himself.
Can EKG say one thing and echo another? He has a stress test on November 13 th. something is clearly wrong with him and he is unable to lead the very active life he always has.
The did an echo after that and emerg doctor said it was normal. I did some Internet searches and found that LVH can be exercise induced. He has all the symptoms on the list; chest pain, shortness of breath, fatigue and dizziness when he exherts himself.
Can EKG say one thing and echo another? He has a stress test on November 13 th. something is clearly wrong with him and he is unable to lead the very active life he always has.
Thanks for writing back.
You are absolutely right, Left Ventricular Hypertrophy on EKG without significant LVH on echo (values for walls of ventricles being upper limit of normal range thus labelled normal) can occur in Athletes. In more severe cases it is called Athletic Heart Syndrome. I am relieved that it is not Aortic Stenosis or Hypertrophic Obstructive Cardiomyopathy and near normal echo studies. Can you request the cardiologist to do an ambulatory BP monitoring on him? For, if this shortness of breath is so much then he can not be taking part in sports/athletics so much. Hypertension, can lead to LVH on EKG and Diastolic Dysfunction on echo. It may be intermittent thus causing no higher reading when recorded. Other thing will be to have his pulmonary function tests done before we say there is no organic cause for shortness of breath and chest pain is functional. If there is no organic disease and these had been satisfactorily excluded then only one makes a diagnosis of functional cause. I can realize your anxiety. Regards.
Sincerely
Dr Anil Grover
You are absolutely right, Left Ventricular Hypertrophy on EKG without significant LVH on echo (values for walls of ventricles being upper limit of normal range thus labelled normal) can occur in Athletes. In more severe cases it is called Athletic Heart Syndrome. I am relieved that it is not Aortic Stenosis or Hypertrophic Obstructive Cardiomyopathy and near normal echo studies. Can you request the cardiologist to do an ambulatory BP monitoring on him? For, if this shortness of breath is so much then he can not be taking part in sports/athletics so much. Hypertension, can lead to LVH on EKG and Diastolic Dysfunction on echo. It may be intermittent thus causing no higher reading when recorded. Other thing will be to have his pulmonary function tests done before we say there is no organic cause for shortness of breath and chest pain is functional. If there is no organic disease and these had been satisfactorily excluded then only one makes a diagnosis of functional cause. I can realize your anxiety. Regards.
Sincerely
Dr Anil Grover
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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