Heart Murmurs: A Serious Problem or Minor Annoyance?

Every year, you schedule your annual physical, knowing that it’s important for your overall health. This time, however, as your doctor listens to your heart, they hear something unexpected: an irregular sound known as a heart murmur. Suddenly, a wave of concern washes over you — heart health is a serious matter, but how serious is a heart murmur? 

“A heart murmur isn’t always a major problem,” says Dr. Francis O’Neill, interventional cardiologist with Beaufort Memorial Heart Specialists. “It may be what we call an innocent heart murmur, a less common occurrence that often goes unnoticed and poses no threat to your health, though should be followed to resolution.”

While some heart murmurs are innocent, others indicate a heart condition that may require expert heart and vascular care. Here’s what you should know about a murmuring heart.

Heart Murmur Basics

A heart murmur occurs when something obstructs, restricts or alters blood flow through the heart or large vessels. Instead of moving smoothly around the heart and through heart valves, blood moves in a turbulent manner that makes noise. Often, we can hear it with the right equipment. Sometimes, we cannot with the usual equipment, and suspicion of a murmur is often the rationale behind a frequently used tool – an echocardiogram. 

Symptoms of a heart murmur may include chest pain or pressure, lightheadedness, as well as palpitations, but many murmurs don’t cause symptoms right away. Your primary care provider detects the issue by listening to your heart with a stethoscope. If you have a heart murmur, your heart will make a sound sometimes described as the following:

• Blowing
• Rasping
• Whooshing
• Clicking

Murmurs are graded on a scale of severity and timing. 

• Severity - Grade 1 through grade 3 murmurs are less severe and can be heard with stethoscope or seen with sonography. Murmurs scored between grades 4 through 6 can often be felt by placing a hand over your chest. This is known as a “thrill” murmur.
• Timing - If your murmur occurs when your heart is in the contractile phase of pumping blood, it’s a systolic murmur. Murmurs that happen when chambers of the heart refill with blood are known as diastolic murmurs.

Read More: Heart Palpitations: The Many Causes of Those Flutters and Flip-Flops

When the Murmur Isn’t a Big Deal

While not all murmurs sound the same with a stethoscope, innocent heart murmurs are described as such because they are generally harmless. These can occur at any age and are especially common in childhood. In fact, the American Heart Association states that between one-third and three-quarters of children experience an innocent murmur by age 14.

Most of the time, innocent murmurs resolve on their own as the diameter of the heart valves or vessels increase or thicken. Some stick around throughout life. No matter what type, it should be evaluated by a healthcare professional as it can be a sign of something more. Because of this, there’s no need to worry about treatment or lifestyle changes, sometimes we just need to observe them over time to ensure they stay “innocent.” 

Read More: 10 Steps to a Healthier Heart

Heart Murmurs Can Mean Something More

Unfortunately, some heart murmurs aren’t so innocent. They point to an underlying health issue that requires treatment. 

“Sometimes, heart murmurs are warning signs that something else is going on with your heart,” Dr. O’Neill says. “Ignoring this type of murmur can put your health and your life in harm’s way.”

Underlying issues often present as problems involving your heart valves. These valves allow blood to pass through your heart’s four chambers. Heart valve disease or damage can result in murmurs and disruption of the flow of blood through the heart can affect the way your heart functions quite drastically.

According to the National Institutes of Health, a few heart conditions known to cause murmurs include:

• Aortic regurgitation - The valve between the heart’s largest blood vessel (aorta) and the left heart chamber doesn’t close all the way. This allows blood to backwash into the left ventricle, reducing the amount of blood pumped into your body. You may experience fatigue, swelling limbs and other unwanted symptoms. It can advance quickly and be associated with other inherited and dangerous conditions.
• Hypertrophic cardiomyopathy - The walls of the heart’s ventricles thicken and may grow stiff. When this happens, your heart effectively pumps less blood and there is often an obstruction created that impedes blood flow. Chest pain and shortness of breath are two common symptoms, although sometimes it is totally silent. It places your heart under strain, while also being commonly associated with inherited protein disorders which can cause both arrhythmic events and loss of consciousness or even death.
• Mitral valve stenosis - Blood passes from the upper to lower heart through the mitral valve. A dysfunction in this valve can leave you feeling out of breath and tired, as well as cause physical findings of fluid overload such as edema.
• Pulmonary regurgitation - The pulmonary valve opens and closes to allow blood to flow to the lungs. Damage or disease allows blood to leak back into the heart before getting to the lungs. 

How to Know What Type of Murmur You Have

Detecting a heart murmur normally takes place when your primary care provider listens to your heart. A systolic murmur is often something that is chronic and can be watched, however a diastolic murmur is rarely, if ever, benign. Further testing or evaluation is necessary to determine if your murmur is innocent or the sign of a serious underlying heart issue.

To move closer to a diagnosis, your provider will perform a physical exam and may prescribe one or more of the following essential tests:

• Chest X-ray - An X-ray is a common imaging service that shows structure problems or growths in the heart and arteries that may need investigation.
• Echocardiogram - Using sound waves, your health provider gets a clear view of your heart. An echocardiogram takes still and moving images to show how well the heart and its valves function.
• Electrocardiogram - Your care provider places a series of wires to your body. These connect to a computer and measure your heart’s electrical activity to detect anything unusual.
• Cardiac MRI (Magnetic Resonance Imaging) - Your provider will refer you to a facility where very succinct imaging of your heart can detect the source of the structural abnormality.
• Cardiac Catheterization - Sometimes complex physiologic questions need to be answered using invasive tools such as a Right and Left Heart Catheterization, which utilizes pressure curves, gradients and injections to ascertain the location and severity of your murmur.

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Treating the Underlying Condition

When another heart condition causes your heart murmur, treating the underlying condition may help correct your heart murmur or prevent it from getting worse. Proper treatment depends on your underlying health condition and overall health. 

The range of treatment options that may help includes:

• Lifestyle changes - Get regular exercise, stop smoking, eat a healthy diet, maintain a healthy weight and keep stress under control. These steps can improve your overall health and help your heart beat strong and function properly.
• Medication - Based on your needs, your heart care team may recommend medication to control high blood pressure, address an abnormal heart rate (arrhythmia) or correct another issue causing your murmur.
• Surgery - In some cases, surgery is necessary to repair heart valves or other structural problems causing a heart murmur. A cardiac surgeon or Interventional/Structural cardiologist may recommend repairing a diseased or damaged valve, or replace it altogether.

“Thanks to continued advances in minimally invasive cardiac surgery, we can now correct underlying heart issues with greater success than ever before, allowing you to enjoy a fuller, longer life,” Dr. O’Neill says. “Before you can get treatment, you must find the problem. This recognition is another reason to prioritize regular visits to your primary care provider and cardiologist.”

Learn more about Heart and Vascular Care at Beaufort Memorial or call 843-770-4550 to schedule an appointment.