Thursday, October 18, 2007
Heart murmurs are often misunderstood

By Anthony Policastro, M.D

This week's lesson will be on physics. That should be a clear sign to everyone who hates physics to stop reading at this point. I will add to the desire to stop reading by being specific. The lesson is on fluid dynamics. Any type of fluid flowing through a system makes noise. The faster the flow, the louder is the noise because rapid flow is more turbulent. The smaller the tube, the louder is the noise because small passageways increase the loudness of noise. This same principle applies to blood flow in the human body. When it is turbulent, it makes noise. When the passageway is narrow, it makes noise. The best example of this is taking blood pressure. When a blood pressure cuff is blown up, it stops the blood flow. Therefore, no noise is present. When the pressure is released the blood starts to flow. However, the artery is partially blocked by the inflated cuff. Thus the flowing blood makes noise. That is the upper number we use for blood pressure. At that number the blood begins to flow. Once the pressure in the cuff drops to a low level, there is no longer any partial blockage to the blood flow. Therefore, the noise stops. That is the lower number that we use. The same principle applies when listening to the blood flow in the heart. All blood flow makes some kind of noise. Therefore, all people have noisy blood flow through the heart. The problem is that our stethoscopes are not able to hear that blood flow. Some of it is related to the fact that stethoscopes are not perfect instruments. There is something called a phonocardiogram. It is a microphone placed on the chest. It listens to an amplified sound of blood flow through the heart. With this instrument, the blood flow can be heard in everyone's heart. The second reason that we cannot hear the blood flow in everyone's heart is that the chest wall is in the way - it muffles the sound. For those two reasons, we cannot hear the blood flow in most people's chests. Children are a little different. Because their chest wall is so thin, we can more easily hear the blood flow. We can hear it in about 20% of children. When we hear normal blood flow through a normal heart, we call it a functional heart murmur or an innocent heart murmur. It is important to remember that it is caused by normal blood flowing through a normal heart making a lot of noise. There is nothing wrong with the heart. I have seen many pediatric patients with functional murmurs. It is so common that I hear one almost every day. Sometimes, I ask parents if they have been told that their child has a heart murmur. When I ask them what they have been told, it is interesting to see their understanding. They know their child has a heart murmur and have been told that it is nothing to worry about. Unfortunately, their interpretation is that their child has mild heart disease. I explain that their child has a normal heart with normal blood flow. The blood is just making a lot of noise. There is nothing to worry about and no need to restrict the child's activities. The noise is nothing more than simple fluid dynamics at work. That is a good lesson to take home.

Nanticoke offers Help for people with lymphedema
Millions of Americans suffer from lymphedema or edema of the arms, legs, trunk or reproductive organs and have not received treatment. The term "edema" refers to an excessive amount of fluid in tissues or organs of the body resulting in swelling. Lymphedema is the swelling of subcutaneous tissue and skin as a result of the malfunction of the lymphatic system. There are two types of lymphedema:
  • Primary - develops when lymphatic vessels are missing or impaired (a rare inherited condition that can present itself at any point in the patient's life).
  • Secondary - develops when lymphatic vessels are damaged or lymph nodes are removed (a result of physical damage or interruption of the lymph system).
  • Being diagnosed with lymphedema is a life-altering event. Suddenly your body doesn't function like it did before. It doesn't look or feel the same. Your self-image and interactions with others may change. You can't do things like you used to. Activities you took for granted may now be difficult or even dangerous. If you or someone you know suffers from lymphedema, there are answers. Contact Nanticoke Health Services at Herring Run, 629-6614, for further information.

    Pot pies recalled for salmonella
    Check your freezer for Banquet or generic store-brand turkey or chicken not-ready-to-eat pot pies with "P-9" printed on the side of the package. If you have any of these pot pie products, the U.S. Department of Agriculture (USDA) says to throw them out. The USDA, CDC, and state health officials are investigating at least 139 cases of salmonella in 30 states that were reported this year and may be related to the pot pies. At least 20 people have been hospitalized in connection with the outbreak, according to the CDC. ConAgra, the manufacturer of the pot pies, reminds consumers to cook the pot pies thoroughly as instructed on the packages. "The cooking instructions for these products are specifically designed to eliminate the presence of common pathogens found in many uncooked products," ConAgra states. So far, health officials haven't proven that the pot pies caused the salmonella cases. But based on interviews comparing foods eaten by patients and people without salmonella, the CDC calls the pot pies "the likely source" of the illness. For more information, including details on refunds for the pot pies, contact ConAgra at 866-484-8671 or

    Red Balloon Hoedown
    The Wellness Community-Delaware is celebrating its growth in Sussex County with a hoedown. Kick up your heels to country music favorites with Brian K. Hall of the CAT Country morning DJ team. The Red Balloon Hoedown will be held Friday, Oct. 19, from 7-11 p.m. at the Baycenter in Dewey Beach. Event sponsors include Delmarva Broadcasting, Cape Gazette and the Tunnell Cancer Center. The event is an opportunity to pay tribute to people in Sussex County whose lives have been touched by cancer. This year, caregivers will also be honored. Tickets are $50 per person and include a tribute balloon that will be displayed at the event. "All of the programs at The Wellness Community are offered at no charge, so the Red Balloon Hoedown is an important fundraiser for us," said Suzanne Landon, Event chair. Landon, a breast cancer survivor, emphasized that there is a tremendous need in Sussex County for the cancer support services provided by The Wellness Community - Delaware. "Through on-site program participation and community outreach efforts, we have had an average of 600 contacts each month since relocating to our new facility on Rt. 24," said Landon. To purchase tickets, contact Barbara Smith or Jo Wilkins by calling The Wellness Community at 302-645-9150. Tickets may also be purchased online at All proceeds from the event will fund support programs for people with cancer and their families in Sussex County.

    Stroke support group
    Nanticoke Memorial Hospital will offer free monthly Stroke Support Group meetings designed for individuals who have survived a stroke and their families and caregivers. Meetings are held the third Thursday of each month at Nanticoke Cancer Care Center, from 1:30 - 3:30 p.m. The meetings will consist of guest speakers and breakaway sessions, in which caregivers and survivors will meet in two groups to discuss concerns, provide support and networking. Refreshments will be provided. Sheila Brant and Joan Burditt, occupational therapists at Nanticoke Memorial Hospital, will facilitate the support group meetings. Pre-registration is not required. For more information, call 629-6611, ext. 5121.

    Nanticoke offers flu shots
    It's time to get a flu shot. Influenza is a serious disease that affects many people, including the elderly and those with serious, long-term health problems. Nanticoke Occupational Health will be offering flue shots to the public on Oct. 19, 24 and 26, located at the Nanticoke Mears Health Campus (across from the Seaford Post Office). The cost of the vaccination is $10. The vaccine is not recommended for anyone under the age of 18. Pre-scheduled appointments are required. The influenza vaccine is recommended for elderly and high-risk individuals. The duration of protection conferred by influenza vaccine generally begins one to two weeks after injection and may last six months or longer. For more information contact Nanticoke Occupational Health at 629-6611, ext. 2505.