Heart Murmurs

Diagnosis

Heart murmurs are often detected during a routine physical exam done for another reason. During the evaluation, your healthcare provider will review your personal and family medical history and listen to your heart using a stethoscope.

When listening to the heart, the provider assesses specific characteristics to determine whether the murmur is innocent or may indicate an underlying heart problem. These include:

• Volume: How loud the murmur sounds on a scale of 1 to 6, with 6 being the loudest.

• Location: Where in the heart the murmur occurs and whether it radiates to the neck or back.

• Pitch: Whether the murmur has a high, medium, or low tone.

• Timing: When the murmur occurs in the heartbeat cycle. A murmur that happens when blood leaves the heart (systolic murmur) is often harmless, while one that occurs when the heart fills with blood (diastolic murmur) or throughout the heartbeat (continuous murmur) may suggest a heart issue.

• Sound changes: Whether the murmur changes with exercise, body position, or breathing.

Tests

If a murmur is thought to be worrisome, additional tests help determine the cause. Common diagnostic tests include:

• Echocardiogram: The main test for diagnosing heart murmurs. It uses sound waves to create images of the heart and shows how blood flows through the heart chambers and valves.

• Chest X-ray: Produces images of the heart and lungs and can reveal heart enlargement, which may contribute to murmurs.

• Electrocardiogram (ECG or EKG): Records the electrical signals of the heart to detect irregular rhythms or damage.

• Cardiac catheterization: Performed when other tests are inconclusive. A thin tube is inserted into a blood vessel and guided to the heart, where dye is injected to visualize blood flow and detect abnormalities.

Treatment

Innocent heart murmurs usually do not require treatment and often resolve on their own, especially when caused by temporary conditions like fever or hyperthyroidism.

For worrisome heart murmurs, treatment depends on the underlying cause. Close medical monitoring, medications, or surgical procedures may be needed to manage the condition effectively.

Medications

Medications can help control the underlying heart conditions that lead to murmurs. These may include:

• Blood thinners (anticoagulants): Help prevent blood clots in patients with irregular heartbeats or conditions that increase stroke risk. Common examples include warfarin, clopidogrel, apixaban, rivaroxaban, and dabigatran.

• Water pills (diuretics): Reduce excess fluid buildup in the body, helping to control blood pressure and ease strain on the heart.

• ACE inhibitors: Lower blood pressure and reduce stress on the heart by relaxing blood vessels.

• Beta blockers: Slow the heart rate and lower blood pressure to improve heart function.

Previously, antibiotics were often prescribed before dental or surgical procedures to prevent heart infections in people with murmurs. This is no longer routinely recommended. Antibiotics are now reserved for specific cases such as people with artificial heart valves, previous heart valve infections, or certain congenital heart defects.

Surgery or other procedures

Surgery may be required if the murmur results from a structural heart problem, such as a damaged or leaky valve. The goal is to repair or replace the faulty valve to restore normal blood flow.

During heart valve repair, the surgeon may:

• Patch holes in the valve

• Separate fused valve leaflets

• Replace the supporting cords of the valve

• Remove extra valve tissue for tighter closure

• Tighten or reinforce the valve’s ring

Heart valve surgery can be performed using different methods depending on the condition and patient’s health, including:

• Open-heart surgery

• Minimally invasive heart surgery

• Robotic-assisted heart surgery

• Catheter-based procedures

The choice of procedure depends on the specific heart abnormality, overall health, and the patient’s suitability for surgery.