Heart Murmur: Information on Causes, Diagnosis & Treatments

Overview

Stethoscope To Listen To Heart Activity During a physical exam the doctor may hear a murmur from the heart muscle. This sound is generated by flowing blood that might possibly pay to pass through a problematic heart valve. Sometimes the condition causes the heart to beat at a faster rate and force the muscle to handle pumping blood throughout the body at a quicker rate than normal. Most heart murmurs are “innocent” and do not necessitate medical treatment. However, there are serious exceptions to the rule, especially when the murmur is associated with an overworked or damaged heart valve. Many individuals with congenital heart problems will develop valve issues later in life or after suffering from other heart conditions.

Causes

There are numerous causes and conditions that can create a heart murmur and cause the heart to beat significantly faster than normal. Many pregnant women suffer heart murmurs if they also have a fever, or overactive thyroid, high blood pressure, or anemia. Typically, these murmurs indicate heart valve problems as the valve opens and closes to allow blood to flow into the upper chambers of the heart (atria) and lower chambers (ventricles). Most heart problems associated with murmurs include:

  • Mitral Valve Prolapse – Typically, the body’s heart muscle mitral valve will need to completely close during the contraction of the lower left heart chamber. When functioning properly, the valve stops blood flow to ensure it does not back up into the upper left chamber. Individuals with damaged or congenital mitral valve problems will develop a prolapse causing the valve to not close properly. Typically, this causes the heartbeat to create a clicking sound. While many mitral valve prolapse problems are not serious, they can cause major regurgitation were significant amounts of blood flow backward into the wrong chambers of the heart.

  • Aortic or Mitral Valve Stenosis – Stenosis can develop if the aortic and mitral valve (both on the left side of the heart) become narrow in size. This condition makes the heart work much harder to pump blood throughout the body. Without treatment, the damaged valve can wear out the heart muscle and cause heart failure. This condition can develop through a congenital birth defect, or as a part of the aging process, or by a rheumatic fever infection that leaves scar tissue on the valve.

  • Aortic Stenosis or Sclerosis – More than thirty percent of the elderly population will develop a heart murmur caused by the stiffening, thickening, or scarring of the aortic valve. Often referred to as aortic stenosis, this condition is usually not dangerous to the patient. Most individuals who develop arterial sclerosis also have heart disease. However, if the valve size narrows progressively, it can form stenosis which leads to shortness of breath, chest pain and fainting. In many cases, the patient requires a replacement of the valve to continue maintaining their quality of life.

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Common Heart Murmur Symptoms

There are no symptoms associated with a heart murmur on its own which usually cannot be heard without a stethoscope. The problem is usually causing the underlying structural issue of heart damage, irregular heartbeat or other condition that is the problem that creates symptoms. That said, many individuals with a heart murmur suffer no consequences and will never experience any symptoms at all. The most common heart murmur symptoms involve:

  • Congenital Heart Disease – Many children are born with congenital heart disease that over time will develop a heart murmur. Usually, the children will have difficulty in breathing or experience a cyanotic condition where blood associated oxygen has become dangerously diminished causing the skin to become bluish in color. This is usually the result of carbon monoxide poisoning. Typically, these infants have other issues including inappropriate weight gain, development, and difficulty when breast or bottle feeding.

  • Heart Abnormalities – Adults, mostly the elderly, can develop murmurs from a heart abnormality. The patient may suffer a variety of associated symptoms of heart failure including chest pain, swelling of the extremities, shortness of breath, irregular heartbeats, palpitations, and other conditions associated with heart valve abnormalities. These include enlarged liver, neck pain, chronic cough, blue colored skin especially on the lips and fingertips, poor appetite, heavy sweating, and sudden weight gain.

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Diagnosing A Heart Murmur

A doctor can typically detect a heart murmur using a stethoscope to listen to the heart muscle while performing a physical examination. However, determining if the murmur is abnormal or “innocent” certain factors must be considered. These include:

  • How loud the murmur sounds to the stethoscope

  • The location of the murmur inside the heart

  • The murmur’s pitch including low, medium, or high pitch

  • How the sound is affected during body repositioning or exercise

  • How often the murmur makes a sound in the length of time it lasts.

The diagnostician will also look for other indicators and symptoms associated with common heart problems. After taking a comprehensive medical history (family and personal) the doctor may suspect that the condition is congenital (a birth defect). Abnormal heart murmurs typically require additional testing that could include:

  • A Chest X-Ray – Taking an x-ray of the chest can provide an image of the blood vessels, lungs, and heart muscle to determine if the organ is enlarged which could indicate a serious underlying condition that produces the heart murmur.

  • An ECG (Electrocardiogram) – Taking a non-invasive EKG will provide a record of electrical impulses of the patient’s every heartbeat. The electrical signals generated by the ECG machine can assist the diagnostician in determining structural problems with the heart and its rhythm.

  • An Echocardiogram – Using ultrasound waves, the technician can obtain a detailed image of the heart’s function and structure which can identify abnormalities in the heart valves including those caused by leaking or calcification caused by hardening tissue or another heart defect.

  • Cardiac Catheterization – The technician will insert a catheter into the artery or vein of the patient’s arm or leg that travels to the interior of the heart. The instrument at the end of the catheter can measure heart chamber pressure or allow a dye to be injected to enhance an x-ray image.

For conclusive results, the technician might need to inject a dye that can be easily seen on an x-ray. This image assists the doctor to determine if there are any problems with the patient’s heart valves, blood vessels or blood flowing through the heart muscle. This type of test is typically reserved for more conclusive results when other tests have failed to provide definitive information.

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Treating Heart Murmurs

Many physiologic (innocent) heart murmurs do not produce any problems for the patient nor require care intervention. These types of heart murmurs are usually the result of a structural issue that can be monitored over time to determine if it is gradually developing into a serious or life-threatening condition. However, more serious murmurs might require an invasive procedure or surgery, especially if the patient is suffering from shortness of breath, chest pain, irregular heartbeats, persistent lightheadedness, and other symptoms. Common treatments include:

  • Surgical procedures to fix leaky or tight heart valves

  • Repair or replacement of mitral valve to correct prolapse problems especially those that cause severe regurgitation

  • Surgical procedure to correct congenital heart problems

  • Intravenous antibiotics to treat endocarditis

  • Surgical removal of cardiac myeloma (benign tumors)

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Sources:

https://www.accessdata.fda.gov/cdrh_docs/pdf13/K131044.pdf

https://my.clevelandclinic.org/health/articles/heart-murmur

https://www.cdc.gov/ncbddd/heartdefects/ventricularseptaldefect.html

https://my.clevelandclinic.org/health/articles/heart-murmur

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