Functional murmur

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Functional Murmur

A functional murmur is a type of heart murmur that is primarily benign and not associated with any structural heart disease. These murmurs are often found in children and young adults and are usually detected during routine physical examinations. Unlike pathological murmurs, functional murmurs do not indicate any underlying heart condition and are generally considered harmless.

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Characteristics

Functional murmurs are typically soft, short, and systolic in nature. They are often described as "innocent" or "physiological" murmurs. These murmurs are usually heard best at the left sternal border or the second to fourth intercostal spaces. They may vary with changes in body position, such as standing or lying down, and can be influenced by factors like fever, anemia, or hyperthyroidism, which increase cardiac output.

Types of Functional Murmurs

There are several types of functional murmurs, including:

  • Still's murmur: A common innocent murmur in children, characterized by a musical or vibratory quality.
  • Venous hum: A continuous murmur heard over the jugular veins, often in children.
  • Pulmonary flow murmur: A soft systolic ejection murmur heard over the pulmonary area, common in adolescents and young adults.

Diagnosis

The diagnosis of a functional murmur is primarily clinical, based on the characteristics of the murmur and the absence of symptoms or signs of heart disease. A thorough physical examination is essential, and in some cases, an echocardiogram may be performed to rule out structural heart abnormalities. However, in the case of a typical functional murmur, further testing is often unnecessary.

Management

Functional murmurs do not require treatment, as they are not associated with any health risks. Patients with functional murmurs can lead normal, active lives without restrictions. Regular follow-up is not typically needed unless new symptoms develop or the murmur changes in character.

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Contributors: Prab R. Tumpati, MD