• Heart Murmur

    Definition

    A heart murmur is an abnormal sound made by turbulent blood flow in the heart. It sounds like whooshing or swishing with each heartbeat. Some adults and many children have incidental heart murmurs that are benign (harmless) and are not caused by abnormalities in the heart. At least 30% of children may have an innocent heart murmur at some point during childhood. However, some heart murmurs can signal an underlying heart problem.
    Heartbeat: Anatomy of the Heart
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Benign murmurs are caused by the normal flow of blood through the heart and large vessels near the heart. The murmur may come and go over time. Some things that can increase blood flow and cause a benign heart murmur to be heard include:
    Abnormal heart murmurs can be due to:

    Risk Factors

    Risk factors for normal heart murmurs include:
    • Age: 3-7 years old
    • Pregnancy
    Risk factors for abnormal heart murmurs include:
    • Rheumatic fever
    • Atherosclerosis
    • High blood pressure
    • Autoimmune disease
    • Congenital heart defects or disease

    Symptoms

    Benign heart murmurs usually cause no symptoms. Patients with mitral valve prolapse sometimes complain of vague chest discomfort and other symptoms. It remains unclear whether or not the valvular abnormality is causing the symptoms.
    Signs and symptoms of abnormal heart murmurs can include:
    • Rapid breathing or trouble breathing
    • Blue lips (cyanosis)
    • Light-headedness
    • Chest pain
    • Palpitations (feeling of rapid or irregular heartbeat)
    • Exercise intolerance
    • Failure-to-thrive in children

    When Should I Call My Doctor?

    If you think that you or your child has a heart murmur, you should see the doctor.

    Diagnosis

    Most benign heart murmurs are diagnosed during the course of a routine physical exam with a stethoscope. Some abnormal heart murmurs are also discovered this way. Other abnormal heart murmurs are discovered initially by their symptoms.
    Tests may include:
    • Electrocardiogram (ECG)—A test that records the heart's electrical activity using electrodes attached to the surface of the chest. This does not diagnose the cause of the murmur but can provide other useful information about the condition of the heart.
    • Chest x-ray—An x-ray to determine the approximate size and shape of the heart, and the presence of associated lung swelling (pulmonary edema).
    • Echocardiogram—A test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart.
    • Cardiac catheterization—A tube inserted into the heart through an artery (usually in the groin) to detect problems with the heart's structure, function, and blood supply.
    • Blood tests—To check for evidence of a recurrent heart attack or other diseases that may affect the heart (such as kidney disease, infections, autoimmune conditions).

    Treatment

    Benign heart murmurs require no treatment. Treatment of other heart murmurs depends on the underlying cause and extent of the problem.
    Treatments include:

    Medication

    Medicines can either treat the cause of the heart abnormality associated with the murmur or help compensate for its dysfunction:
    • Diuretics, angiotensin-converting enzyme inhibitors, digitalis—to treat heart failure
    • Antibiotics—to prevent or treat endocarditis

    Surgery

    Surgery is often necessary to treat severe heart abnormalities:
    • Replacement of defective heart valves with artificial ones
    • Correction of congenital heart defects
    • Removal of heart tumors

    Prevention

    Preventing benign heart murmurs is unnecessary. To help reduce your risk of developing an abnormal heart murmur:
    • Get prompt testing and treatment for strep throat to prevent rheumatic fever.
    • Reduce your risk of atherosclerosis to help prevent valvular heart disease in the distant future. To do this:
    Although not routinely recommended for every type of heart murmur, you may need to take antibiotics before and after some medical or dental procedures that could allow bacteria to enter your bloodstream. Ask your doctor if you need to take preventive antibiotics.

    RESOURCES

    American Heart Association http://www.heart.org

    Heart Information Network http://www.healthcentral.com

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca

    Canadian Family Physician http://www.cfpc.ca

    References

    American Dental Association. Antibiotic prophylaxis. American Dental Association website. Available at: http://www.ada.org/2157.aspx. Accessed August 30, 2010.

    American Heart Association. New guidelines regarding antibiotics to prevent infective endocarditis. American Heart Association website. Available at: http://www.heart.org/HEARTORG/. Accessed August 30, 2010.

    Berkow R. The Merck Manual of Medical Information . New York, NY: Pocket; 2000.

    Heart murmur in children. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 17, 2011. Accessed February 9, 2012.

    Heart murmurs. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/More/CardiovascularConditionsofChildhood/Heart-Murmurs%5FUCM%5F314208%5FArticle.jsp. Accessed July 6, 2009.

    Heart murmurs. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/heart-murmurs/DS00727. Updated April 9, 2010. Accessed February 9, 2012.

    Heart murmurs and your child. KidsHealth website. Available at: http://kidshealth.org/parent/medical/heart/murmurs.html. Updated August 2010. Accessed February 9, 2012.

    Medical dictionary: heart disease and stroke. Harvard Medical School Consumer Health Information website. Available at: https://www.health.harvard.edu/dictionary/heart-disease-stroke.htm . Accessed July 6, 2009.

    Revision Information

    • Reviewer: n/a
    • Review Date: 06/2012
    • Update Date: 02/14/2013
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