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Heart murmurs are either a congenital or acquired disease. A doctor diagnoses heart murmurs using a stethoscope to listen to the sounds of the heart. When blood flows rapidly or abnormally through the heart valve, it will make whooshing or swishing sounds which called heart murmur.
If the doctor does hear a murmur, they will order some test to help determine whether the murmur is a sign of heart valve problem. It can be harmless (innocent) but sometimes it can be a sign of serious heart condition. A doctor will choose the best treatment procedure based on the cause of heart murmurs.
Symptoms
Unlike harmless or innocent heart murmurs, worrisome heart murmurs mostly cause symptoms which differ from person to person, depending on the cause.
The followings are certain symptoms of heart murmurs:
- Blue fingernails or lips
- Chest tightness
- Chronic cough
- Heart palpitations
- Difficulty breathing
- Dizziness
- Liver swelling
- Bulging veins in the neck
- Syncope
- Heavy sweating
- Decreased appetite in infants
- Growth problems in infants
- Swelling
Although heart murmurs in general do not require immediate medical care, one is advised to schedule an appointment with a doctor if the disease keeps making you concerned. You may need to do some tests to rule out a health problem.
Causes
A rapid turbulent blood flow through the heart can cause heart murmurs in any of the following events:
- Diastolic murmur: When the heart is pumping blood to the body.
- Systolic murmur: When the heart muscle relaxes and the heart is filling up with blood.
- Continuous murmur: Heart murmur happens throughout the heartbeat.
Harmless (innocent) heart murmurs
This is mostly found in kids and newborn babies. However, anyone with a healthy heart might have harmless heart murmurs too. Although those with harmless heart murmurs might recover on themselves over time, in some patients the disease might be present throughout their life without severe symptoms.
These following factors can cause harmless heart murmurs:
- Fever
- Anemia, which is caused by a low amount of normal red blood cells responsible for delivering oxygen to body tissues
- Hyperthyroidism
- Rapid growth (in adolescence)
- Physical activities
- Pregnancy
Worrisome heart murmurs
Certain congenital heart defects that affect the structure of the heart can cause worrisome heart murmurs among kids.
These congenital defects include:
- Holes in the heart. A baby in the womb can have a hole between the upper and/or lower heart chambers. The conditions such as atrial septal defects and ventricular septal defects.
- Cardiac shunts. In kids, worrisome heart murmurs are caused by a congenital defect related to the structure of the heart that causes irregular blood flow between the heart chambers or blood vessels. But, for those who develop this problem later on (acquired heart valve disease), it is due to irregular heart valves.
Things that can damage the heart valves include:
- Calcium deposits. A heart valve with a buildup of calcium causes the valve to be unable to completely close, making the blood back up and changing the direction of blood flow, leading to heart murmurs. This condition is also called calcific or degenerative valve disease. Valve stenosis, or the stiffening or narrowing of a heart valve, can affect any valve, such as the mitral valve or the aortic valve.
- Endocarditis: This is when the inner heart lining and valves get infected with certain bacteria or germs and due to this untreated infections of a valve can cause heart murmurs.
- Rheumatic fever: One with strep throat can develop this kind of fever as a severe complication if leaving the disease untreated. Heart valves can be affected by rheumatic fever, which is a condition called rheumatic heart disease that can lead to heart murmurs.
Risk factors
Newborn have a risk of developing heart murmurs if they have any of the following:
- Family history: related to heart problems.
- Mother with uncontrolled diabetes during pregnancy
- Infections during pregnancy: Pregnant women that were infected with German measles, or rubella.
- Alcohol/drug consumption: Pregnant women who abuse alcohol and drugs.
Those with any of the following health disorders are put at a higher risk of developing heart murmurs:
- Carcinoid syndrome: A rare malignant tumor that causes chemical leakage in the bloodstream.
- Cardiomyopathy: Weakens the heart muscles.
- Endocarditis: Infection of cardiac tissue.
- Anemia: Low red blood cell count
- Hypereosinophilic syndrome
- Autoimmune diseases: Lupus, rheumatoid arthritis
- Diseases that affect valves of the heart
- Pulmonary hypertension
- History of rheumatic fever
- Hyperthyroidism
Diagnosis
Heart murmurs are usually diagnosed during are routine checkup, while the doctor listens to the heart as well as asks about your health condition.
Many following aspects of heart sounds heard through a stethoscope are considered for disease diagnosis:
- Volume: A scale of from 1 to 6 (least to most loud) is used to tell the volume of heart murmurs.
- Location: The murmuring sound tells which part of the heart is affected by the disease and helps confirm if it has spread to some other areas such as the neck or the back.
- Pitch: Heart murmurs might create a high, medium or low pitched voice.
- Timing of the murmur: There are different kinds of heart murmurs depending on the occurrence of the disease. Innocent heart murmurs are mostly systolic murmurs, which occur when blood is pumped out of the heart. Severe murmurs which tell that there is a cardiac problem, on the other hand, are either diastolic murmurs, which occur when blood is filling the heart, or continuous murmurs, which are ones that happen throughout the heartbeat.
- Sound changes. A patient is required to lie down or exercise during diagnosis to let the doctor see how the heart’s sound changes during these activities.
Tests
A doctor might use any of the following tests to find the cause of worrisome heart murmurs:
- Echocardiogram: Shows how the heart is beating and the blood flow in the heart and valves through pictures made with sound waves.
- Chest X–ray: Shows pictures of the heart and lungs to help detect an enlarged heart.
- Electrocardiogram (ECG or EKG): Detects irregularities of electrical activity of the heart. The doctor places electrodes on the chest, the arms or legs to monitor the cardiac electricity, which are connected to a computer to show results.
- Cardiac catheterization: In this procedure, your doctor will insert a catheter into a blood vessel of the groin before guiding it to the heart. Contrast materials might be injected through the catheter for clearer images of blood vessels. Doctors tend to use this procedure after other testing methods have failed to detect heart murmurs.
Treatment
Unlike worrisome heart murmurs that require careful medical attention and treatment with medications and surgery, harmless heart murmurs usually go away on their own without treatment.
Medications
A doctor uses certain medications as follows to treat heart murmurs:
- Anticoagulants: The medications disrupt the forming process of blood clots. The clots raise the risk of strokes and are associated with arrhythmias, which may be a sign of certain defects that cause heart murmurs. There are many options of blood thinners, including warfarin, clopidogrel, apixaban, rivaroxaban and dabigatran.
- Diuretics. The drugs are given to lower blood pressure and treat other conditions that contribute to heart murmurs by preventing fluid buildups inside the body.
- Angiotensin–converting enzyme (ACE) inhibitors. As hypertension provokes symptoms of heart murmurs, this medication will regulate a patient’s blood pressure.
- Beta blockers. Medication to control heart rate and blood pressure. Unlike the past, people who suffer from worrisome heart murmurs nowadays are not required to take antibiotics to prevent heart infections during surgery or dental procedures. A doctor may prescribe antibiotics only for patients who have a high risk of cardiac infection. This includes those who have artificial heart valves, a history of heart valve infections or congenital heart defects.
Surgery or other procedures.
A doctor might recommend surgery to cure the cause of a worrisome heart murmur. For example, if your heart valve is thickening or leaking, resulting in heart murmurs, your doctor might recommend surgery to fix or replace that disordered heart valve.
The process of surgery to repair a heart valve includes:
- Patching a heart valve’s holes
- Separating valve leaflets that are joining together
- Replacing the cords that support heart valve
- Making the valve close normally by removing theexcess valve tissue.
- Making the ring around a valve tighter
Options for heart valve surgery include:
- Open-heart surgery
- Minimally invasive surgery
- Robot-assisted surgery
- Cardiac catheterization
Your doctor will assess your health conditions to determine the best way to perform surgery.
