Heart murmurs are whooshing or swishing sounds created when blood flows abnormally over your heart valves. This sounds can be heard through the use of a stethoscope.
A typical heartbeat makes two sounds like “lubb-dupp” (sometimes described as “lub-DUP”) when the heart valves are closing. If your heart makes a whooshing or swishing sound instead, that’s called a heart murmur. A murmur means blood is flowing abnormally across your heart valves.
Heart murmurs are common and don’t necessarily indicate a health problem, especially in children. However, murmurs should be evaluated because they may signal a heart problem or other health issue.
Heart murmurs are quite common. In fact, most people had experience an innocent heart murmur at some point during childhood time. They can be congenital (present at birth) or acquired (develop later in life).
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Types of heart murmurs
Harmless (innocent) heart murmurs. A person with an innocent murmur usually has a typical heart. Innocent heart murmurs are common in newborns and children.
Worrisome heart murmurs. In children, worrisome murmurs are usually due to a problem with the heart’s structure that’s present at birth (congenital heart defect). In adults, this are usually due to heart valve problems that develop later in life (acquired heart valve disease).
They are classified based on when they happens in a heartbeat:
- Systolic murmur: This type of murmur occurs when your heart muscle contracts (tightens).
- Diastolic murmur: This type of murmur occurs when your heart muscle relaxes.
- Continuous murmur: A continuous heart murmur happens during both contraction and relaxation of your heart muscle.
The diastolic and continuous murmurs are most likely related to heart problems and disease. But every heart murmur should be evaluated.
Symptoms of heart murmurs
In many cases, heart murmur and other abnormal heart sounds can only be detected when health professionals listens to your heart beats or sounds using a stethoscope.
Harmless or innocent heart murmur usually don’t cause any other symptoms.
Symptoms of worrisome heart murmur depend on the cause. This symptoms may include:
- shortness of breath
- chest pain
- chronic cough
- dizziness or fainting
- heavy sweating with little exertion
- skin that looks blue, especially on your lips or fingertips
- sudden weight gain or swelling
- enlarged liver
- enlarged neck veins
In some cases, most heart murmurs aren’t serious. If you’re concerned about a heart murmur, you should seek a medical attention.
You can also read about types and symptoms of heart attack.
Causes of heart murmurs
Murmurs are caused by rapid, choppy (turbulent) blood flow through the heart. A heart murmur can be:
- Diastolic murmur. When the heart is filling with blood.
- Systolic murmur. When the heart is emptying.
- Continuous murmur. Throughout the heartbeat.
Harmless (innocent) heart murmurs. A person with an innocent murmur usually has a typical heart. Innocent murmurs are common in newborns and children.
The following are the things that might change blood flow and cause an innocent heart murmur:
- Lack of healthy red blood cells that carry oxygen to body tissues (anemia)
- Fever
- Overactive thyroid (hyperthyroidism)
- Phases of rapid growth, such as adolescence
- Pregnancy
- Physical activity or exercise
This kind of murmurs may go away over time. Sometimes, a heart murmur continue for life without causing serious health problems.
Worrisome heart murmurs. In children, worrisome murmurs are usually due to a problem with the heart’s structure that’s present at birth (congenital heart defect). In adults, this are usually due to heart valve problems that develop later in life (acquired heart valve disease).
Congenital causes of heart murmurs may include:
- Holes in the baby heart. This hole may form before birth in the wall between the upper or lower heart chambers, or both. Examples are atrial septal defect and ventricular septal defect.
- Cardiac shunts. This heart structure problem present before birth (congenital heart defect) causes irregular blood flow between the heart chambers or blood vessels.
The following are the things that can damage the heart valves in adults:
- Endocarditis (Infection of the inner heart lining and valves). Bacteria or other germs cause this infection. The germs spread through the blood to the heart from another part of the body, such as the mouth. A murmur may occur if the infection is untreated and affects the heart valves.
- Calcium deposits. This can cause a heart valve, such as the mitral valve or the aortic valve, to become stiff and narrow (valve stenosis). A calcified valve also may not close completely, letting blood flow backward. The changes in blood flow create a murmur. When calcium affects the heart valves, it’s called calcific or degenerative valve disease.
- Rheumatic fever. This result as a serious complication of strep throat. It’s a rare condition. Rheumatic fever may occur in those who don’t get or complete treatment for strep throat. When rheumatic fever affects the heart valves, it’s called rheumatic heart disease. A heart valve problem can cause a murmur.
Risk factors of heart murmurs
The following are the factors that can increase the risk of murmurs in babies:
- Uncontrolled diabetes in the mother during pregnancy
- Family history of heart problems linked to murmurs
- Use of certain medications, alcohol or illegal drugs by the mother during pregnancy
- German measles (rubella) in the mother during pregnancy
Medical conditions that can increase the risk of murmurs include:
- A weakened heart muscle (cardiomyopathy)
- A rare cancerous tumor that releases certain chemicals into the bloodstream (carcinoid syndrome)
- An infection of the lining of the heart (endocarditis)
- Anemia
- Blood disorders marked by a high number of certain white cells, called eosinophils (hypereosinophilic syndrome)
- Certain autoimmune disorders such as lupus and rheumatoid arthritis
- Heart valve disease or defect
- High blood pressure in the lungs (pulmonary hypertension)
- Overactive thyroid (hyperthyroidism)
- History of rheumatic fever
You can also read about causes and risk factors of high blood pressure.
Prevention of heart murmurs
Heart murmur can’t be prevented. But you can avoid serious or severe problems from a heart condition or disease by getting your heart checked properly and regularly.
Diagnosis of heart murmurs
Your doctor will diagnose a heart murmur by listening to your heart. A murmur makes an abnormal swishing or whooshing sound.
You cannot hear a murmur with just your ear. You will need a stethoscope, which makes the sounds loud and precise enough to hear.
Your doctor will classify murmurs by how intense or loud they are. Using a scale of 1 (the murmur can barely be heard, even with a stethoscope) to 6 (it can be heard clearly, even when the stethoscope isn’t pressing on your skin).
Your doctor will listens to your heart with a stethoscope from several different places on your chest and also back. He or she will listen for certain things in your heartbeat, which include:
- Lub-dub (normal heart sound) instead of swishing or whooshing sounds.
- Pitch.
- Rhythm.
- Volume.
- Timing.
Your provider (Doctor) may also ask you to do several things while listen:
- Sit.
- Grip your hands.
- Squat.
- Lie down.
- Stand suddenly.
If your doctor hears a murmur, you may need to be further tested, to rule out a health problem or heart disease. You may be referred to a cardiologist, a physician who specializes in the heart.
This cardiologist can evaluate what’s causing your condition, by performing the following tests to determine the cause of your heart murmur:
- Electrocardiogram: Electrocardiogram(also called an ECG or EKG) is a painless test that measures the electrical activity of your heart.
- Echocardiogram: Echocardiogram (also called an echo) uses sound waves to create images of your heart’s valves and chambers. It helps examine your heart’s pumping action. This can be a surface ultrasound or a more specialized ultrasound procedure through your mouth and esophagus, which gives better pictures than the surface ultrasound.
- Chest X-ray: A chest X-ray takes pictures inside your chest to find any structural problems.
You can also read about Prevention and diagnosis of stroke.
Treatment of heart murmurs
The Innocent (harmless) heart murmurs don’t usually require treatment. If other factors like a fever or an overactive thyroid (hyperthyroidism) is causing the murmur, the murmur usually goes away once that condition is treated.
Management of the worrisome heart murmur depends on the cause. This requires close monitoring by your healthcare provider. In worrisome heart murmur, medications or surgery may be used for treatment.
Drugs that might be used to treat heart conditions that are associated with murmurs include:
- Water pills (diuretics). This medicine removes excess fluid from the body. A diuretic may be given to treat high blood pressure or other conditions that can make heart murmurs worse.
- Blood thinners (anticoagulants). This type of medicine prevents blood clots. Some conditions that cause heart murmurs are closely linked to irregular heartbeats (arrhythmias) that can cause blood clots. Blood clots increase the risk of strokes. Blood thinners include warfarin (Jantoven), clopidogrel (Plavix), apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa) and others.
- Beta blockers. A beta blocker lowers heart rate and blood pressure.
- Angiotensin-converting enzyme (ACE) inhibitors. This type of drug lowers blood pressure. High blood pressure can worsen underlying conditions that cause heart murmurs.
Antibiotics are only recommended in specific situations. For instance, they may be recommended for those with artificial heart valves, people with history of heart valve infections or congenital heart defects that increases the risk of infection inside the heart.
In some situations, surgery may be needed to correct a condition that is causing a worrisome murmur. For example if a narrowed or leaky heart valve is causing the heart murmur and other symptoms, heart valve repair and replacement may be needed.
Surgery of heart valve may be done as:
- A procedure using flexible tubes (catheter procedure)
- Open-heart surgery
- Minimally invasive heart surgery
- Robotic heart surgery
What to expect from the surgeon during a heart valve repair:
- The surgeon will patch holes in a valve
- The surgeon will separate valve leaflets that have fused
- The surgeon will replace the cords that support the valve
- The surgeon will remove excess valve tissue so that the valve can close tightly
- The surgeon will tighten or reinforce the ring around a valve
The way the surgery or procedure is performed depends on the specific heart condition or defect.
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