Cardiac murmurs should be evaluated as to intensity (grades 1 to 6), timing (systolic or diastolic), location, transmission, and quality (musical, vibratory, or blowing): Show
The murmur grade is recorded as 1/6, and so on. The next step in evaluating a murmur is its classification in relation to S1and S2. The three types of murmurs are systolic, diastolic, and continuous. An infant with no murmur may still have significant cardiac disease. Systolic Murmurs Most heart murmurs are systolic, occurring between S1 and S2. Systolic murmurs are either ejection or regurgitation murmurs. They are a normal finding during the routine physical exam of a healthy infant. Studies have shown that as many as 90% of healthy children have a benign murmur at some time. The blood flow causes ejection murmurs through stenotic or deformed valves or increased flow through normal valves. Regurgitant systolic murmurs begin with S1, with no interval between S1 and the beginning of the murmur. Regurgitation murmurs generally continue throughout systole. Regurgitation systolic murmurs are caused by blood flow from a chamber at a higher pressure throughout the systole than in the receiving chamber. Regurgitation systolic murmurs are associated with only three conditions:
Diastolic Murmurs Diastolic murmurs are classified according to their timing in relation to heart sounds as early diastolic, mid-diastolic, or pre-systolic. They are usually pathologic. They result from aortic regurgitation and pulmonary insufficiency. With aortic regurgitation, the murmur is high-pitched and blowing. It begins with the second heart sound and is loudest in early diastole. It may be missed because it is often very soft or may be mistaken for breath sounds because of its high pitch. Bounding pulses are present. The murmur of pulmonary insufficiency is a distinctive diastolic murmur. It is low-pitched, early in onset, and of short duration. It ends well before the first heart sound. It occurs with postoperative TOF, pulmonary hypertension, postoperative pulmonary valvotomy for pulmonary stenosis, or other deformities of the pulmonary valve. Mid-diastolic murmur results from abnormal ventricular filling. Due to stenosis, the murmur results from turbulent flow through the tricuspid or mitral valve. They are associated with mitral stenosis or large left-to-right shunt VSD or PDA, producing relative mitral stenosis secondary to increased flow across the normal-sized mitral valve. It is seen in the atrial septal defect (ASD), total or partial anomalous pulmonary venous return (TAPVR, PAPVR), endocardial cushion defects, or abnormal stenosis of the tricuspid valve. Continuous Murmurs Most continuous murmurs are not audible throughout the cardiac cycle. They begin in systole and extend into diastole. They are a pathologic finding. They can be produced in rapid blood flow, high-to-low pressure shunting, and localized arterial obstruction. The most significant is the PDA high-to-low shunting. The patency of the ductus is normal in the first 24 hours of life, but a few weeks later, a patent ductus is abnormal. It is more common in girls (sex ratio of 3:2), tends to affect siblings, and may be a complication of maternal rubella. It is six times more common in infants born at high altitudes and more common in premature infants. There may be a vigorous pericardial activity, a systolic thrill, and bounding pulses if the ductus is large. There may be symptoms of congestive heart failure (CHF).
 Patent ductus arteriosus (PDA) is a heart condition in babies. It happens when a blood vessel called the ductus arteriosus doesn’t close as it should after birth. What does the ductus arteriosus do?During fetal development (before a baby is born), very little blood flows to a baby’s lungs. Instead, most of the blood bypasses the baby’s lungs. One way for this to happen is that blood flows from the main heart artery (aorta) to the primary lung artery (pulmonary arteries) through a special fetal blood vessel (ductus arteriosus). This blood vessel usually closes during the baby’s first few days of life when the blood flows to the baby’s lungs. What happens in babies with patent ductus arteriosus?When a baby has a PDA, the ductus arteriosus doesn’t close properly. A small opening is left. The opening allows extra blood from the aorta to enter the baby’s lung arteries. Depending on the size of this blood vessel, your baby’s heart and lungs may have to work harder to pump blood. Who does PDA affect?Babies born prematurely are more likely to have a PDA. The condition is also more common in girls than boys. How common is PDA?Patent ductus arteriosus is the most common heart condition in newborns. Healthcare providers diagnose the condition more often in premature babies. The risk increases the earlier the baby is born. PDA happens in about:
How does PDA affect my baby?A moderate or large PDA can cause babies to breathe faster and harder than normal, as their bodies try to keep up with the extra blood in their lung arteries. If left untreated for a prolonged period, a PDA can lead to the development of pulmonary hypertension (high blood pressure in the lungs) and blood vessel damage.
Researchers don’t know for sure why this condition happens. Patent ductus arteriosus causes may include genetic disorders or a family history of the condition. Other PDA causes may include:
What are patent ductus arteriosus symptoms?PDA symptoms vary according to patent ductus arteriosus types. Small PDAs may not cause any symptoms other than a heart murmur. Larger PDAs may cause:
If you notice symptoms of a PDA in your baby, tell your healthcare provider. Your provider may hear a patent ductus arteriosus heart murmur during a well-baby care visit or physical examination. What tests do providers use to diagnose patent ductus arteriosus?If your healthcare provider suspects PDA, they may recommend referral to a specialist, a pediatric cardiologist. The pediatric cardiologist may order certain tests, including:
Do healthcare providers diagnose PDA in adults?Healthcare providers sometimes diagnose PDA in adults. If you had a small PDA as a baby, you may not have gotten treatment. Symptoms can include:
Your healthcare provider will consider your baby’s age, size and health when determining a treatment plan. They might recommend observation (watchful waiting) to see if the PDA will close on its own. A watchful waiting approach involves regular checkups and tests so the provider can see if the PDA is closing. Occasionally, treatment may not be necessary. What medications do providers use to treat PDA?Healthcare providers may treat patent ductus arteriosus with medication, including nonsteroidal anti-inflammatory drugs (NSAIDs). Medications may encourage patent ductus arteriosus closure. This is commonly used in premature babies, but not in older children or adults. What are other types of patent ductus arteriosus treatment?Healthcare providers may treat PDA with surgical procedures, including:
How soon after treatment will blood flow return to normal?After catheterization or surgery, blood flow returns to normal immediately if there are no other heart defects. Are there other complications from PDA?Closing the PDA gets blood flow back to normal. After closure via a cardiac catheterization, your child will take antibiotics for six months to prevent heart infection (endocarditis). Your healthcare provider will discuss the necessary follow-up care with you. Adults who have PDA closure procedures will also take antibiotics for six months and should see a cardiologist for follow-up care.
There isn’t anything you can do to prevent PDA. Are there conditions that put my baby at higher risk for PDA?If you have rubella during pregnancy, your baby may be at higher risk of developing PDA. Tell your healthcare provider right away if you’re exposed to rubella during pregnancy.
With treatment, most babies born with PDA live healthy and active lives. Is patent ductus arteriosus curable?If PDA doesn’t close on its own, healthcare providers can correct it, if needed. Babies and children with moderate and large sized PDA’s that are not treated in the correct timeframe may be at higher risk for developing heart complications as adults. Talk with your healthcare provider about whether your baby needs follow-up care.
Follow all instructions from your healthcare provider. Keep all follow-up appointments and let your provider know right away if your baby develops new symptoms. When should I call my healthcare provider?Call your provider if your baby develops new symptoms. If your baby has trouble breathing, seek emergency care right away. A note from Cleveland Clinic Patent ductus arteriosus (PDA) is a congenital heart condition. With treatment, your child can live an active and healthy life. Talk with your healthcare provider about the best treatment options.
Last reviewed by a Cleveland Clinic medical professional on 04/25/2022. References
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A nurse is assessing a newborn for manifestations of a large patent ductus arteriosus
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