What Are Heart Murmurs?

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Heart murmurs may signal a potentially serious health issue, but they’re often benign and require no treatment.

HOW ALARMED SHOULD YOU be if your doctor says you have a heart murmur? Not very, absent additional tests that suggest a serious problem, says Dr. Mouin Abdallah, a cardiologist with the Cleveland Clinic. He’s also medical director of the clinic’s Center for Coronary Artery Disease. Heart murmurs are abnormal sounds emanating from the heart, caused by the turbulence of blood flow as it courses within the organ, Abdallah says. A heart murmur isn’t a disorder or a disease, but it could be a sign of a problem in the organ. For example, it may suggest heart valve disease or a hole in the heart, conditions which would typically require cardiac evaluation and treatment. Or, a heart murmur could be benign and not signal any disease. About 10 percent of the U.S. adult population will have a benign heart murmur at some point in his or her lifetime, Abdallah says. Heart murmurs are more common in children, and pediatricians are trained to diagnose them to determine which murmurs are benign and which require testing.

Many murmurs emanate from a healthy heart, says Dr. Vincent J. Bufalino, president of the Advocate Heart Institute, a system of hospitals in the Chicago area. He’s also a spokesman for the American Heart Association. “A number of these are what we call ‘innocent’ or benign,” Bufalino says. “They don’t indicate any heart problem. That’s pretty common.” It’s important to keep in mind that heart murmurs can be related to non-heart-related conditions, like anemia, pregnancy, a high fever or very high thyroid levels, says Dr. Michael Y. Chan, a cardiologist with St. Joseph Hospital in Orange, California.

These are the basic types of heart murmurs:

  • Systolic murmur.
  • Diastolic murmur.
  • Continuous murmur.

1. Systolic murmur. A systolic murmur occurs during a heart muscle contraction, says Dr. Steven W. Tabak, a cardiologist and medical director for quality of the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles. One example of a systolic murmur could indicate leakage of the mitral valve, which is on the left side of the heart between the left atrium and the left ventricle, he says. The function of the mitral valve during the heart’s rest phase is to allow blood to flow freely into the ventricle. It closes during contraction to allow blood to go forward into the rest of the body and not back into the atrium, he says. A heart murmur could signal that the mitral valve isn’t functioning properly, which could compromise its function in allowing proper blood flow, Tabak says.

2. Diastolic murmur. This type of murmur happens in the phase between the contraction, between heartbeats. The most common diastolic murmur involves leakage of the aortic valve, Tabak says. This is the last valve that blood crosses as it leaves the heart to go into the body. A heart murmur could signal an issue with the aortic valve, which could compromise its ability to allow blood to flow from the heart into the body, Tabak says.

3. Continuous murmur. A continuous murmur is one that “occurs throughout the cardiac cycle,” according to Stanford Health Care. These kinds of murmurs typically occur in infants, young children, adolescents and adults in their 20s, Abdallah says. Unlike systolic and diastolic murmurs, continuous murmurs aren’t related to a valve issue, he says. Rather, they typically indicate a congenital heart issue that’s been present at birth and may be diagnosed at a later time, Tabak says.

Heart Murmur Diagnosis

Here are the typical ways doctors diagnose heart murmurs:

  • Stethoscope. Doctors often detect heart murmurs by listening to a patient’s heart with a stethoscope. Physicians can sometimes tell whether a murmur is benign by listening with the tool. Doctors use a scale of 1 to 6 – with 6 being loudest – when listening for a heart murmur, says Dr. Morton Tavel, a cardiologist based in the Indianapolis area. The physician will also listen for a high, medium or low pitch, trying to determine whether the sound is affected by certain maneuvers such as a particular body position, Tavel says. “An experienced examiner can usually make the distinction (between benign heart murmurs and those that call for additional testing), for various murmurs are typically characterized by pitch, duration and primary location in the body,” Tavel says. Additional tests may be required for difficult cases, he says. A cardiologist could order these additional tests:
  • Chest X-ray. A chest X-ray can reveal if the heart is enlarged, which may suggest an underlying condition, like heart valve disease, Tabak says. A chest X-ray may also reveal changes in the shape and size of your heart, which may suggest heart failure, according to the Mayo Clinic.
  • Electrocardiogram. This is a noninvasive test in which probes are placed on the patient’s chest to record electrical impulses. This tool helps physicians detect problems with a heart’s structure and rhythm, Bufalino says.
  • Echocardiogram. An echocardiogram uses ultrasound waves to examine the heart. This device shows, in great detail, images of the organ. Doctors use echocardiograms to find abnormal heart valves and other defects, Bufalino says.
  • Cardiac catherization. This invasive exam involves a catheter being placed into a vein or artery in the patient’s leg or arm until it reaches his or her heart, Bufalino says. This allows physicians to measure the pressures in the heart chambers. Physicians can inject dye, which can help them evaluate blood flow in the heart, valves and blood vessels. This approach is typically used when other tests have been inconclusive.

Heart Murmurs in Babies Versus Heart Murmurs in Adults

A “high percentage” of children will more than likely have a benign heart murmur “at some time,” according to the American Heart Association. How high a percentage? Very, according to the Children’s Hospital of Philadelphia, which says that about 75 percent of all newborns have normal, or benign, heart murmurs. By comparison, about 10 percent of adults will have a heart murmur at some point in their lives. “Asymptomatic innocent flow murmurs are common in otherwise healthy children,” says Dr. Salina Graves, medical director at Independence Blue Cross, based in Philadelphia. “These murmurs result from the audible sounds of normal blood flow through blood vessels behind thin walls. There are several other types of innocent murmurs that can be detected in children that do not require treatment.” Some heart murmurs in children and adults can be indicative of heart disease, and would require the patient to undergo a thorough medical examination, she says.

Heart Murmur Treatments

No treatment is needed for a benign heart murmur, Bufalino says. So-called innocent murmurs that are caused by conditions like a high fever or hyperthyroidism stop when the condition dissipates or is successfully treated.


original article by Ruben Castaneda, Staff Writer March 25, 2019: U.S. News and Report

Ruben Castaneda has worked at U.S. News since September 2016.
Mr. Castaneda has written extensively about Baby Boomer health and exercise habits, strategies for losing weight, health care issues affecting distressed communities, yoga and substance misuse. In 2018, the National Press Foundation chose Mr. Castaneda as one of 15 journalists nationwide to participate in a deep dive seminar into reporting on the opioids crisis. In 2017, the USC Center for Health Journalism named Mr. Castaneda one of 24 journalists chosen from around the nation to participate in the center’s National Fellowship. Mr. Castaneda was awarded a grant from the Dennis A. Hunt Health Journalism Fund. The grant helped support Mr. Castaneda’s reporting for a five-part series U.S. News published focusing on how the Trump administration’s immigration policies are affecting the health and well-being of children of immigrants, their parents, and health care providers and teachers who work with the kids. He has appeared multiple times on “Just Ask David,” a podcast that covers health and beauty issues. Before joining U.S. News, Mr. Castaneda worked as a reporter for 22 years at The Washington Post, where he primarily covered crime in the District of Columbia and courts and police misconduct in Prince George’s County, Maryland. His 2014 nonfiction book, “S Street Rising: Crack, Murder and Redemption in D.C.” chronicles Mr. Castaneda’s struggle with crack addiction while covering the crime beat for the Post during the violent crack era. The Post named “S Street” one of 50 notable works of nonfiction published that year. Mr. Castaneda has also appeared on NPR, CNN’s “Reliable Sources” and on several local TV news shows. He has written for Politico, Washington City Paper, Los Angeles Weekly and Hispanic Magazine. Mr. Castaneda is a member of the Association of Health Care Journalists and the National Association of Hispanic Journalists. Mr. Castaneda graduated with a degree in journalism from the University of Southern California and completed a six-week fellowship at Duke University, part of a partnership with The Post. You can follow Mr. Castaneda on Twitter, and LinkedIn, or learn more about him on Wikipedia.

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