A heart murmur can sound scary—literally. A Keck Medicine of USC cardiologist explains why it might not be as scary as you think. As Oana Maria Penciu, MD, a cardiologist with the USC Cardiac and Vascular Institute, part of Keck Medicine of USC, explains, understanding what that sound means and what’s causing it are key to living happily and healthily with a heart murmur.
“Lub-dub…lub-dub…lub-dub…” That’s the sound a healthy heart makes as its valves close after each pump. Your doctor wants to hear this sound when listening to your heartbeat with a stethoscope. But if the sound your doctor hears is more of a “whoosh” or “swish,” that may signal that you have a heart murmur.
What causes a heart murmur?
A whooshing or swishing sound in your heart will perk up your doctor’s ears because it means that the blood is flowing a little faster or more turbulently than usual.
But, Dr. Penciu notes, “It’s important to know that a heart murmur is a sound—not a disease in itself.”
In the case of what’s known as a functional, or innocent, heart murmur, that turbulence is completely harmless and not even uncommon in healthy people, including children, athletes and pregnant women.
“Pathological murmurs, on the other hand, may indicate a problem with one or more of the heart valves,” Dr. Penciu says. These problems can include narrowing (stenosis) or leaking (regurgitation).
These valve problems can arise with age and the normal wear-and-tear a heart experiences over a lifetime. But heart defects present from birth, as well as prior infections like rheumatic fever and infective endocarditis, which affects the heart’s lining and valves, might also be to blame.
Finally, cardiomyopathies, or diseases of the heart muscle itself, can cause heart murmurs, Dr. Penciu says, “particularly when the muscle becomes abnormally thick.”
How do doctors diagnose a heart murmur?
If a doctor hears a particularly unusual whooshing or swishing sound, they might refer you to a cardiologist for further tests to determine what’s going on.
Those tests will often start with an electrocardiogram (EKG) and echocardiogram, or ultrasound of the heart. But should your doctor need a better idea of how your heart muscles, chambers and valves are operating, they might order a chest X-ray, cardiac MRI or CT scan or other tests, too.
People diagnosed with heart murmurs might not notice any symptoms, even if their murmurs are caused by heart muscle or valve conditions. But if such conditions progress, chest discomfort, shortness of breath, fatigue and difficulty exercising, swollen legs, trouble sleeping and lying flat at night and even dizziness, lightheadedness and fainting could develop.
“If any of these symptoms appear, especially if they’re new or worsening,” Dr. Penciu emphasizes, “it’s time to call your doctor.”
How do you treat a heart murmur?
What happens if a heart murmur goes untreated?
In the case of an innocent murmur, possibly nothing. But heart murmurs caused by severe valve or heart-muscle disease can overwork the heart, leading to complications like heart failure, stroke or irregular heart rhythms.
“Fortunately,” Dr. Penciu says, “most cases are detected early and can be effectively managed.”
For example, cardiomyopathy-related heart murmurs respond well to medications and, in some cases, surgery, pacemakers or defibrillators. And patients can usually manage mild to moderate valve-related murmurs with medications that lower strain on the heart and control blood pressure and heart rhythm.
“Severe valve disease, however, may require valve repair or replacement,” Dr. Penciu notes. “The approach varies depending on the valve involved and the patient’s overall condition, and it may range from minimally invasive procedures to traditional open-heart surgery.”
A skilled care team knows how to determine the right treatment.
As Dr. Penciu says, “If testing reveals moderate or severe valve disease, heart failure or abnormal heart rhythms, it’s best to be evaluated at a comprehensive cardiovascular center. These centers provide advanced imaging, specialized valve teams and minimally invasive treatments that can greatly improve outcomes and quality of life.”
Living with a heart murmur
And quality of life for people with heart murmurs can be quite high.
“Most patients, especially those with innocent murmurs, live completely normal and full lives,” Dr. Penciu says. “They can work, exercise, travel and enjoy normal activities. Even those with valve disease can remain active and healthy when they follow up regularly with their doctor and receive treatment at the right time.”
That’s great news, because staying active is an important part of managing a heart murmur.
And while we can’t prevent all heart murmurs, we can reduce the risk of developing valve-related ones—and in some surprising ways.
“Treating strep throat promptly helps prevent rheumatic fever, which can damage valves,” Dr. Penciu points out. “Good dental hygiene lowers the risk of infections that can spread to the heart, too. Managing blood pressure and cholesterol also helps protect the heart, and avoiding intravenous drug use reduces the chance of infective endocarditis.”
But if you do develop a heart murmur, rest assured. “A heart murmur is simply a clue—not a verdict,” Dr. Penciu says. “With routine checkups, healthy habits and the right care team, most people with a heart murmur can expect to live long, active, fulfilling lives.”
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Source: University of Southern California.
