Heart Murmur: What the Sound Means and When a Murmur Needs Follow-Up

What it involves

MedlinePlus defines a heart murmur as a blowing, whooshing or rasping sound heard during a heartbeat. It says the sound comes from turbulent, or rough, blood flow through the heart valves or near the heart. A murmur is a finding on exam, not a diagnosis by itself.

Who this is for

• Patients told at a checkup or a school or work physical that a murmur was heard
• Patients with a known murmur who have new shortness of breath, chest pain or swelling
• Patients with a family history of heart problems who want their heart listened to
• Parents who were told a child has a murmur and want to understand what that can mean

What to expect

• Questions about chest pain, fainting, breathing problems and any family history of murmurs or heart disease
• Your provider listening to your heart with a stethoscope, sometimes while you squat, stand or hold your breath
• An EKG at the Loxahatchee and West Palm Beach offices if your provider thinks it is useful
• A referral for an echocardiogram or to a cardiologist if the murmur needs a closer look

How a murmur is heard and described

MedlinePlus explains that murmurs are graded by how loud they sound through a stethoscope, on a scale of 1 to 6. A grade I murmur can barely be heard and comes and goes, and a description such as grade II/VI means grade 2 on that scale. A murmur is also described by when it is heard, either in systole, as the heart squeezes blood out, or in diastole, as it fills. When a murmur is louder, a provider may feel it with the palm over the heart, which the encyclopedia calls a thrill.

Many murmurs are harmless

MedlinePlus says many heart murmurs are harmless. These are called innocent murmurs, they cause no symptoms or problems and they do not need specific cardiac treatment. Extra blood flow through the heart can cause one, and its examples include exercise, pregnancy, high emotional stress, fever or illness, anemia and hyperthyroidism. For that reason a provider may look at the whole picture, and the anemia guide and the thyroid care page explain two causes that are checked with blood work. Children often have murmurs as a normal part of development.

When a murmur reflects a valve problem

Other murmurs can signal an abnormality in the heart. The encyclopedia lists problems of the aortic, mitral and tricuspid valves, pulmonary valve stenosis and hypertrophic cardiomyopathy. In the MedlinePlus health topic on heart valve diseases, the two basic problems are regurgitation, where a valve does not close tightly and blood leaks backward, and stenosis, where a valve is thick or stiff and does not open all the way. The same page says many people live their whole lives with a valve that does not work perfectly and never have problems, though valve disease can slowly worsen.

Symptoms worth reporting

MedlinePlus lists shortness of breath, fatigue, swelling in the feet, ankles, abdomen or neck veins, chest pain with physical activity, an irregular heart rhythm, and dizziness or fainting as possible signs of heart valve disease. The shortness of breath guide, the leg swelling guide and the fainting guide each explain how a provider sorts these symptoms. Chest pain that is sudden or severe is a different matter, and the chest pain guide explains when to call 911 instead of booking a visit.

What testing may follow

The encyclopedia says the tests that may be done are a chest x-ray, an electrocardiogram and echocardiography. Serenity By A Dr. Sareen lists EKGs at the Loxahatchee and West Palm Beach offices, as the EKG and heart health screening page describes. Echocardiography, the ultrasound picture of the heart, is a referral, not something this practice performs. The health topic adds that a provider who hears an abnormal sound will usually refer you to a cardiologist, a doctor who specializes in heart diseases.

If a valve problem is found

MedlinePlus says most heart valve problems can be treated successfully. Treatment may include medicines to control symptoms, heart-healthy lifestyle changes and, sometimes, surgery to repair or replace a valve, which is decided with a heart specialist. It also notes that untreated valve disease can strain the heart, and the heart failure management page describes ongoing primary care for that condition. A rhythm that feels irregular is a separate question, and the atrial fibrillation guide explains it.

Sources

• MedlinePlus — Heart murmurs (medical encyclopedia)
• MedlinePlus — Heart Valve Diseases (health topic)