During a general physical, physicians use a stethoscope to listen to your heart. Typically your doctor will hear your heart making a strong, healthy lub-DUP sound. That sound comes from the opening and closing of a heart valve. Any additional swishing or wooshing sounds may indicate that a patient has a heart murmur.
Many heart murmurs are “innocent” or harmless and do not require any additional treatment. Children will oftentimes have “innocent” heart murmurs and there may not be a need to pursue any additional testing or treatment. If there are additional concerns, an “innocent” heart murmur can be evaluated using an electrocardiogram (ECG) or echocardiogram (echo) in the office. Again, “innocent” heart murmurs require no additional treatment and do not indicate a higher risk for developing cardiovascular disease.
An abnormal heart murmur is can be accompanied by other symptoms which can include shortness of breath, fingers or toes turning blue, chronic cough, sudden weight gain, swelling, chest pain, dizziness, fainting, sweating with little to no exertion, enlarged veins in the neck or an enlarged liver. In adults, an abnormal heart murmur is usually due to a heart valve problem.
Abnormal heart murmurs can happen when heart valves harden or narrow making it more difficult for blood to flow through the heart and causing a detectable murmur. They can also occur from valves that leak. Frequent cases of heart murmurs are congenital valve abnormalities. Aortic stenosis (a narrowed aortic valve) and mitral valve prolapse ( an often leaky valve) are two very common causes of a heart murmur.
During an examination we we can evaluate the heart murmur on a number of metrics including the volume and pitch of the murmur, where the murmur is located, if body position affects the murmur and the duration and pattern of the murmur. If following an examination with a stethoscope we believe the heart murmur may be abnormal, there are a number of options we may pursue. A chest x-ray, allows us to see any potential enlargement of the heart that could be causing the murmurs. An Electrocardiogram (ECG) examining the electric activity of your heart helps us determine issues in heart rhythms or structural issues. An echocardiogram(echo) can also help us evaluate the structure of the heart and look for leaking or hardened valves. If all of these tests are inconclusive and we’re still concerned about the murmur, a further evaluation may be necessary.
Depending on the specific cause of you heart murmur, we will follow a treatment of medication or surgery. Some of the medications are we may prescribe are diuretics, anticoagulants, ACE inhibitors, statins, or beta-blockers. We might also recommend surgery to either repair a valve or in more severe cases replace the valve.