Heart murmurs

Description

Heart murmurs are sounds, such as whooshing or swishing — made by rapid, jerky, (turbulent) blood flow through the heart. The sounds can be heard with a device called a stethoscope. A typical heartbeat makes two sounds like "lubb-dupp" (sometimes described as "lub-DUP") when the heart valves are closing.

Heart murmurs can be present at birth (congenital) or develop later in life (acquired).

Some heart murmurs are harmless (innocent). An innocent heart murmur is not a sign of heart disease and do not need treatment. Other heart murmurs may be a sign of a serious heart condition. You need tests to check the heart and heart valves. Heart murmur treatment depends on the cause.

Symptoms

Harmless (innocent) heart murmurs usually does not cause any other symptoms.

The symptoms of the worrisome heart murmurs depend on the cause. Heart murmur symptoms may include:

  • Blue or grey fingernails or lips
  • Pain in the chest
  • Cough that does not go away
  • Dizziness
  • Inflammation of the liver
  • Swollen neck veins
  • Fainting
  • Profuse sweating with little or no activity
  • In infants, lack of appetite and lack of growth
  • Shortness of breath
  • Swelling or sudden weight gain

When to see a doctor

The majority of heart murmurs are not serious. If you are worried about a heart murmur, make an appointment to see your primary care provider. Your doctor can tell you if follow-up care is necessary.

Causes

A heart murmur is caused by rapid, jerky, (turbulent) blood flow through the heart. A heart murmur that can happen:

  • When the heart fills with blood (diastolic murmur was found)
  • When the heart is emptying (systolic murmur)
  • All the heartbeat (continuous murmur)

Harmless (innocent) heart murmurs

A person with an innocent murmur usually has a typical heart. Innocent murmurs are common in infants and children.

Things that could change the flow of blood and cause a heart murmur is innocent, which include:

  • Fever
  • The lack of red blood cells, which carry oxygen to the tissues of the body (anemia)
  • Overactive thyroid (hyperthyroidism)
  • Phases of rapid growth, such as adolescence
  • Physical activity or exercise
  • Pregnancy

Innocent murmurs may disappear with time. Sometimes, the murmurs continue for life, without cause serious health problems.

Worrisome heart murmurs

In children, worrying murmurs are usually due to a problem with the heart's structure that's present at birth (congenital heart defect).

The congenital causes of worrying heart murmurs are:

  • Holes in the heart. A hole may be formed before birth in the wall between the top or bottom of the chambers of the heart, or both. Examples are the atrial septal defect and ventricular septal defect.
  • Cardiac shunts. A heart of the problem of the structure present prior to birth (congenital heart defect) causes irregular blood flow between the chambers of the heart or the blood vessels.

In adults, the worrisome heart murmurs are usually due to heart valve problems that develop later in life (acquired heart valve disease). Things that can damage the heart valves include:

  • The calcium deposits. The calcium deposits can cause a valve in the heart, such as mitral valve or aortic valve become stiff and narrow (stenosis of the valve). A calcified valve also may not close completely, letting the blood flow backwards. The changes in the blood flow, create a buzz. When the calcium affects the valves of the heart, is called calcific or degenerative disease of the valve.
  • The infection of the interior of the heart lining and valves (endocarditis). The bacteria, or other germs to cause this infection. Germs are spread through the blood to the heart from another part of the body, as the mouth. A breath can occur if the infection is treated and affects the heart valves.
  • Rheumatic fever. This is a serious complication of strep throat. It is rare in the united States. Rheumatic fever can occur in those who did not receive or complete the treatment for strep throat. When rheumatic fever affects the heart valves, it is called rheumatic heart disease. A heart valve problem can cause a murmur.

Risk factors

Things that increase the risk of heart murmurs in babies include:

  • Family history of heart problems linked to the murmurs
  • Uncontrolled diabetes in the mother during pregnancy
  • German measles (rubella) in the mother during pregnancy
  • Use of certain medications, alcohol or illegal drugs by the mother during pregnancy

Some medical conditions may increase the risk of heart murmurs, including:

  • A rare cancerous tumor that releases certain chemicals into the bloodstream (carcinoid syndrome)
  • A weakness of the heart muscle (cardiomyopathy)
  • An infection of the heart lining (endocarditis)
  • Anemia
  • Blood disorders marked by a high number of certain white blood cells, called eosinophils (hypereosinophilic syndrome)
  • Certain autoimmune disorders such as lupus and rheumatoid arthritis
  • Heart valve disease
  • High blood pressure in the lungs (pulmonary hypertension)
  • History of rheumatic fever
  • Overactive thyroid (hyperthyroidism)

Prevention

There is no known prevention for heart murmurs. But the changes of a healthy lifestyle can improve your heart health and prevent some of the conditions linked to the murmurs in adults. Many of the childhood heart murmurs go away on their own as children grow.

Heart murmurs

Diagnosis

Heart murmurs can be detected when a physical examination is done for another reason. You will be asked questions about your personal and family medical history.

A health care provider can hear the heart through a device called a stethoscope. The provider considers several things when listening to the heart in order to know if an innocent murmur or worrisome. Some of those things are:

  • Volume. How strong is the murmur in the heart, on a scale of 1 to 6? The strongest blow in the heart is 6.
  • Location. Where the heart is? Does the sound spread to the neck or back?
  • Field of play. It is high, medium or serious?
  • Duration of the murmur. A murmur that occurs when the blood leaves the heart (systolic murmur) is usually an innocent heart murmur. That happens when the heart fills with blood (diastolic murmur was found) or over the heart beats (continuous murmur) may be a sign of a heart problem.
  • Sound changes. No exercise or change the position of the body affects the sound?

Tests

Tests are done to determine the cause of the disturbing heart murmurs. Blow into the heart of the tests may include:

  • The echocardiogram. This is the main test used to determine the cause of a heart murmur. An echocardiogram uses sound waves to create images of the beating heart. Shows how blood flows through the heart and the heart valves.
  • X-ray of the chest. An x-ray is an image of the heart and the lungs. You can determine if the heart is enlarged. Increase in the size of the heart can cause some heart murmurs.
  • Electrocardiogram (ECG or EKG). This quick and painless test that measures the electrical activity of the heart. During an ECG, sensors (electrodes) are attached to the chest and, at times, the arms or the legs. The sensor cables are connected to a machine that prints or displays the results. A health care provider can be seen in the patterns of the signals to detect signs of heart problems.
  • The cardiac catheterization. This test may be done when other tests have not found a cause for the heart murmur. A heart doctor (cardiologist) inserts a flexible tube (catheter) into a blood vessel, usually in the groin or wrist. The catheter is gently guided to the heart. Contrast dye may be injected through the catheter. The dye helps the vessels to be seen best in pictures taken during the test.

Treatment

Innocent heart murmurs often don't need treatment. If fever or an overactive thyroid (hyperthyroidism) causes a murmur, the murmur will usually go away once that condition is treated.

The treatment for a worrying heart murmur depends on the cause. A worrying heart murmur requires close supervision by a health care provider. Medication or surgery may be necessary.

Drugs

Drugs that can be used to treat diseases of the heart associated with the puffs are:

  • Blood thinners (anticoagulants). This kind of drug prevents the formation of blood clots. Some conditions that cause heart murmurs are closely linked to irregular heartbeats (arrhythmias), which can cause blood clots. Blood clots that increase the risk of stroke. Blood thinners include warfarin (Jantoven), clopidogrel (Plavix), apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), and others.
  • Water pills (diuretics). This medication removes excess fluid from the body. A diuretic may be prescribed to treat high blood pressure or other conditions that can cause heart murmurs worse.
  • Angiotensin-converting enzyme (ACE) inhibitors. This type of medication that lowers blood pressure. High blood pressure can worsen underlying conditions that cause heart murmurs.
  • Beta-blockers. A beta-blocker reduces the heart rate and blood pressure.

In the past, many people with worrisome heart murmurs were told to take antibiotics before surgery or dental work to prevent certain infections of the heart. That the recommendation has changed. The antibiotics are only recommended in specific situations. For example, you may be recommended for people with artificial heart valves, a history of heart valve infections, or congenital defects of the heart which increases the risk of infection in the inside of the heart.

Surgery or other procedures

Surgery may be needed to correct a condition that causes a worrying heart murmur.

For example, if a narrowed or leaky heart valve is causing the breath and other symptoms, heart valve repair or replacement may be necessary.

During heart valve repair, a surgeon can:

  • Patch holes in a valve
  • Separate the valve leaflets that have been fused
  • Replace the cables that support the valve
  • Remove the excess tissue of the valve so that the valve can be closed tightly
  • Tighten or reinforce the ring around the valve

Heart valve surgery can be done as:

  • Open heart surgery
  • Minimally invasive heart surgery
  • Robotic heart surgery
  • A procedure using a flexible tube (catheter procedure)

The way in which the surgery or procedure that is performed depends on the condition of the heart.

Preparing for your appointment

If you are worried about a heart murmur, make an appointment to see your health care provider of the family. Although the majority of heart murmurs are harmless, it is a good idea to check for any underlying heart problems that can be serious. You may be referred to a doctor who specializes in heart conditions (cardiologist).

Appointments can be brief. So it's a good idea to be prepared for your appointment. Here's some information to help you to be prepared and know what to expect from your health care provider.

What you can do

  • Be aware of any pre-appointment restrictions. Ask if there is something that you need to do before your appointment. For example, if you are having a certain type of echocardiogram, you may need to avoid eating or drinking anything for several hours before the test.
  • Write down your symptoms, including any that may seem unrelated to the murmurs of the heart.
  • Write your family medical history, including a family history of heart murmurs, heart rhythm problems, heart defects, coronary artery disease, genetic disorders, stroke, high blood pressure or diabetes.
  • Write down the major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you or your child is taking. Include the dose.
  • Have a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who comes along with you can remember something that you missed or forgot.
  • Be prepared to discuss your diet and exercise habits. If you or your child no longer follow a diet or workout routine, be ready to talk with your health care provider about the challenges that you might face in the introduction.

Time with a provider of health services is limited. Prepare a list of questions can help you make the most of their time together. To murmurs of the heart, some basic questions to ask your provider include:

  • What is the most likely cause of the heart murmur?
  • What are other possible causes for the heart murmur?
  • What kind of tests are needed?
  • What is the best treatment or follow-up care?
  • What are the alternatives to the primary approach you're suggesting?
  • How should other health conditions that the heart murmur be managed?
  • Is there any diet or exercise of the restrictions that must be followed?
  • You should see a specialist?
  • If surgery is necessary, the surgeon would I recommend?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material that I can take my house? What sites do you recommend to visit?

What to expect from your doctor

Your health care provider is likely to ask you a few questions. Be prepared to answer them you can save your time to go through all the information that you want to spend more time. Your provider may ask:

  • What are the symptoms? Include any history of fainting, chest pain, leg swelling, skin color changes, and difficulty breathing.
  • When did the symptoms begin?
  • Are the symptoms constant or come and go?
  • How severe are the symptoms?
  • What, in any case, it seems that the symptoms better?
  • Does anything make the symptoms worse?
  • Have you ever used illegal drugs?
  • There is a history of rheumatic fever?
  • Did anyone else in the family has a heart murmur or a heart valve problem?
Symptoms and treatment of heart murmurs