It happens during most medical examinations. The doctor lifts a stethoscope to a patient’s chest, everyone stops talking and the doctor listens to your heart.
If an unusual sound appears, well, you’ve got a heart murmur. But, it’s not automatically a warning sign of danger.
A heart murmur naturally creates concern for a patient when it’s diagnosed, but it’s only a sound. It is important to determine what is causing the murmur and to have it monitored. When heart valves are too stiff, too loose or aren't formed properly, blood flow may sound more like a swishing or whooshing noise, rather than the normal “thump-thump.”
“If it's a new finding, or if it's associated with any type of symptoms, it deserves to be evaluated,” said Dr. Mark Mitchell of Novant Health Cardiology in Winston-Salem. “The easiest way to do that is an ultrasound test of the heart, which can show you the structure, the valves, and whether there is any problem with the heart muscle or blood vessels. It is a very easy test to determine whether the murmur has any serious significance.”
Heart murmur symptoms
Heart murmurs are classified as either “innocent” or “abnormal.” If you have an innocent heart murmur, you likely won't have any signs or symptoms other than what the doctor hears in the stethoscope. Innocent murmurs aren’t dangerous, they sometimes disappear over time and generally don’t require medical intervention.
Innocent heart murmurs can be caused by physical activity or exercise, pregnancy, fever, anemia, hyperthyroidism, or a rapid growth phase in adolescents.
An abnormal heart murmur, depending on what’s causing it, may have these symptoms:
- Skin that appears as blue, especially on fingertips and lips.
- Shortness of breath, chest pain, dizziness or fainting.
- Swelling or sudden weight gain.
- Chronic coughing.
- An enlarged liver or neck veins.
- In infants, poor appetite and failure to grow normally.
- Heavy sweating with little or no activity.
“Symptoms are frequently related to blood not moving properly from the heart to the body,” Mitchell said. “That can be due to either an obstruction of blood flow if one of the valves narrows, or it can be blood moving in the wrong direction. If a valve leaks, sometimes when the heart beats, the blood will actually go backwards. Sometimes there's a hole in the heart between the right and the left side of the heart, which is called a shunt.”
Heart murmur causes
In adults, abnormal murmurs are most often caused by heart valve problems. In children, abnormal murmurs are usually caused by structural problems of the heart. Some common congenital defects that cause heart murmurs include:
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- Holes in the heart.
- A shunt, which is an abnormal blood flow between the heart chambers or blood vessels.
- Valve problems, including valves that don't allow enough blood through (stenosis) or valves that do not close properly and leak (regurgitation).
In older children and adults, causes of abnormal heart murmurs include infections and conditions that damage the heart structure, including hardening of the valves, an infection of the inner lining of your heart (endocarditis) and rheumatic fever, which is rare.
What to do if you’re diagnosed with a murmur
“You should get an evaluation by a specialist that deals with heart murmurs,” Mitchell said. “They determine if there are any symptoms, they'll frequently order an echocardiogram (an ultrasound test to get pictures of the heart and the valves). If that looks normal, I think that allays a lot of anxiety among the patients.”
“If it's abnormal, and the patient turns out to have some problem with the structure of the heart, although you don't want to have that news, it's good news because then you can be evaluated and determine what the best course of action is.”
Heart murmur treatment
Treatment of a murmur depends on the heart condition causing the murmur and may include medications or surgery. Medications you may receive include blood thinners to prevent blood clots, diuretics to remove excess water from your body, statins to lower cholesterol, beta blockers to lower heart rate and blood pressure, and angiotensin-converting enzyme (ACE) inhibitors, which also lower blood pressure.
Surgery may be necessary to repair a heart valve that causes a murmur. Many times, a heart valve needs to be replaced, which can involve open-heart surgery, or a less invasive procedure, depending on the location and severity of the valve.