Heart Murmur:
Symptoms, Causes, Diagnosis & Treatment

3.Heart Murmur causes

Causes of an innocent heart murmur:

An innocent heart murmur is caused when the blood is flowing faster than it normally does through the heart. An innocent heart murmur can be caused due to any of the following.

• You might be suffering from anaemia due to which your body is unable to get enough oxygen as there aren’t enough healthy red blood cells to carry oxygen-rich blood.
• You might have a fever.
• You might be doing intense physical activity or exercising due to which rapid blood flow is taking place through your heart.
• You might be pregnant.
• Children who are becoming adolescents and are growing fast tend to have innocent heart murmurs.
• You might have hyperthyroidism.

Causes of an abnormal heart murmur:

Abnormal heart murmurs can be caused due to the following problems:

Children and babies who are born with abnormal heart valves have abnormal heart murmurs. These are usually found when they become adults, which is when they suffer from problems such as regurgitation where the valves leak due to improper closing. Another problem is stenosis in which insufficient blood flows through the valves.

Abnormal heart murmurs can occur due to cardiac shunts or septal defects, which are holes in the heart. This usually affects infants and children. Their severity depends on where the holes are and what size they are. Holes in the heart can lead to abnormal heart murmurs when the blood is flowing abnormally between the blood vessels.

Rheumatic fever can lead to abnormal heart murmurs. Rheumatic fever is a serious condition that should be treated on time without delay. Although rheumatic fever is now rare, it can affect the heart valves directly leading to an abnormal flow of blood. This causes abnormal heart murmurs.

Adults who have mitral valve prolapse can have abnormal heart murmurs. This is the problem where the mitral valve is unable to close properly due to a section of the valve ballooning out. This can cause abnormal heart murmurs due to the backward flow of the blood through the valve, which can be serious.

Endocarditis can cause abnormal heart murmurs to occur. Endocarditis occurs when there’s an infection in your heart’s lining. This infection can be due to bacteria present in any part of your body that settles in your heart. If endocarditis isn’t treated, it can damage the heart valves leading to abnormal heart murmurs.

Valve calcification is another leading cause of abnormal heart murmurs. This condition is developed when the aortic valve has calcium deposits on it. This leads to a problem at the aortic valve opening as it becomes narrow. This can cause abnormal heart murmurs as it becomes difficult for the blood to flow.

7.Diagnosis and Treatment of Heart Murmur

Diagnosis of heart murmurs

There are different types of heart sounds. How do you determine what heart murmur sounds like? Your doctor is the one who will be able to detect heart murmurs and their type when he listens to your heartbeat using a stethoscope. If you have a physical exam, your doctor will be able to detect any heart murmurs during that time. Various factors will help your doctor determine whether the heart murmur is an innocent heart murmur or an abnormal heart murmur. One of the factors is how high pitched, or low pitched the heart murmur is.

Another factor that helps your doctor determine whether the heart murmur is innocent or abnormal is how loud the heart murmur is. On a scale of 1 being the lowest and 6 being the highest, your doctor notes how loud the murmur is. Your doctor will check where the heart murmur is coming from by determining where it can be heard from. Your doctor will determine whether changing your body’s position and exercising has any effect on the sound or the heart murmur. An important factor that your doctor will find out is how long the murmur is taking place and when it occurs.

If you have a diastolic murmur whereby the heart murmur takes place when blood fills your heart, it might indicate an underlying heart problem. If you have a continuous murmur whereby the heart murmur occurs during a heartbeat, it might indicate a heart problem too. Systolic murmurs are usually innocent heart murmurs but at times can indicate a problem in your heart. If by this time your doctor suspects that you have an abnormal heart murmur, he might suggest that you have extra tests done to find out the exact cause of the problem. These tests are as follows.

• A blood test is used by your doctor to check if you have any infection. This is usually for people who might have pericarditis or endocarditis.
• An echocardiogram helps your doctor to see how your heart structure is and how it functions. This procedure helps to see if there are any abnormal heart valves.
• A chest X-ray helps your doctor take a look at your blood vessels, heart, and your lungs. It can help to see if your heart has become large due to any problem.
• Cardiac catheterization is used by your doctor to measure the pressure that is available in the chambers of your heart. A dye can be used in addition to see how blood flows through your heart and how your heart valves and blood vessels are functioning.
• An electrocardiogram or ECG is used to measure electrical impulses and signals. This helps your doctor determine if you have any heart structure or rhythm problems.
• A doppler echocardiography helps your doctor view in the pattern of the way in which the blood is flowing.

Apart from these tests, your doctor might order other tests to be performed based on your heart problem.

Treatment of heart murmurs

If you are diagnosed with an innocent heart murmur, there are chances that you won’t require any treatment since there is no potential threat. If innocent murmurs have occurred because of a condition such as fever, the heart murmurs will stop once treatment for the condition is given. If your doctor diagnoses you with an abnormal heart murmur, then two things can happen. Your doctor might want to monitor you for some time to see how the condition progresses. If it doesn’t pose a threat, no treatment might be required. Another option is treatment.

Two types of treatment can be given - medicines or surgery. Medications prescribed by your doctor will be for treating the heart problem that is causing the heart murmurs to occur. You might be prescribed statins which help to lower cholesterol levels in your body. Heart murmurs can be made worse when you have a high level of cholesterol in your body. Your doctor might prescribe diuretics which are water pills. These are used to remove extra fluid from your body that can lead to worsening of heart murmurs. Beta-blockers can be prescribed for lowering heart rate and managing blood pressure.

Anticoagulants can be prescribed by your doctor to prevent the formation of blood clots. Clopidogrel and warfarin are often prescribed so that blood clots don’t form in your heart as these can lead to stroke. Your doctor might prescribe ACE inhibitors which help reduce blood pressure. These are just some of the common types of medications that can be prescribed by your doctor. Your doctor might recommend other types of medications depending on your condition and which heart problem you are suffering from. Antibiotics can be recommended to prevent an infection from occurring in the heart.

Heart valve problems cannot be treated only with medicines. At times, your heart valve disease needs surgery to be performed. If valve repair is the best treatment option for you, your doctor can recommend any of the procedures as follows.

Annuloplasty is the procedure that is used when there is an abnormal valve opening present in your heart. Your doctor performs surgery whereby the tissue that surrounds the valve is fit together so that it is tight. This is performed with the help of an artificial ring. Once this is done, the cusps of the valve can fit perfectly together and close like they normally should.

Your doctor can recommend valve leaflet repair if you have a faulty cusp. He can do this in various ways, depending on the type of repair that is required. Your doctor can cut the cusp so that it operates properly. Else, he might separate the cusps through surgery, or he may pleat the cusp or leaflet.

Balloon valvuloplasty is a medical procedure that treats a narrow valve. A small catheter is used in this surgery where there is a balloon attached on end. Your doctor threads it and guides to your heart so that it can be properly placed inside the valve. The balloon is inflated so that the narrow valve becomes wider and normal blood flow can occur.

Structural support repair is used when the structural support needs to be repaired. This is done by shortening the papillary muscles and the chordae tendineae, or by replacing the cords that are there to support your heart valves. This is generally used to alleviate the problem of leakage that can sometimes occur due to a heart valve problem.

If the valve repair option is not right for you, your doctor might recommend you have your valve replaced.

Transcatheter aortic valve replacement or TAVR is a minimally invasive procedure that can be recommended by your doctor. In this surgery, a mechanical valve is used to replace the aortic valve. This approach is made by making a small incision in your chest. Another option to perform TAVR is to use a catheter. This type of surgery is not the first option because doctors recommend it to those people who suffer from severe aortic valve stenosis and who are not good candidates for aortic valve stenosis.

Open-heart surgery is another option that your doctor might recommend. Doctors most often recommended this. It is used for treating severe valve stenosis. A tissue valve is used to replace a valve in your heart that has become narrow. Tissue valve can come from someone who has died, or from animals such as a cow or a pig. Tissue valves need replacement eventually. It is possible to use an autograft at times. A mechanical valve can be used instead of a tissue valve, but it requires you to take blood thinners because it has the risk of blood clot formation.

You and your doctor will sit down and discuss the available treatment options. Which option is best for you depends on various factors, and you shouldn’t make your decision in a rush. Instead, you should speak to your doctor openly about your fears and any questions that you might have regarding the treatments that you can choose from. Don’t forget to ask your doctor why he recommends a certain treatment option and how it can impact your life in the future.

8.Outlook and Prognosis

Children and adults who have innocent heart murmurs have an excellent outlook since the murmurs are harmless and usually go away on their own. For other heart murmur types, the prognosis depends on the type of underlying problem, the severity of the problem, and treatment. When you get prompt treatment, the prognosis is favourable, which is why timely diagnosis and prompt treatment is necessary in case of heart murmurs. Your doctor will tell you about your outlook and prognosis depending on your condition of heart murmurs and the treatment.

9.Road to Recovery and Aftercare

Your doctor will let you know about how you can recover and how to take care of yourself. Certain medications might be prescribed at first, and other times you might need to undergo surgical treatments. Your rate of recovery will depend on your age, whether you have other heart conditions, your overall physical health, and whether you are willing to make any lifestyle changes. You might need to follow a specific diet and lifestyle after treatment, and if you follow what your doctor says, then you might heal faster. Asking your doctor about precautions and how you can recover is a good idea.

10.Heart Murmur FAQs: All your concerns addressed

Q.   Is heart murmur a disease?

1. People wrongly assume that a heart murmur is a disease, but it isn’t. You need to remember that a normal healthy person can have heart murmurs too. However, there is nothing wrong with getting yourself screened to ensure you are healthy, and your heart health is as it should be.

Q.   What is the duration of the heart murmur?

1. There is no particular duration of a heart murmur. An innocent heart murmur that occurs due to exertion can go away as soon as you stop doing the activity and relax. If you have a heart murmur due to fever, the heart murmur goes away as soon as the condition is treated. If your child has consistent innocent murmurs, they will go away on their own as he grows. When heart murmurs are caused due to an underlying heart problem, the heart murmur duration depends on the type of heart problem you have. While some can worsen over time, others gradually get better.

Q.   When should I consult a doctor?

1. You should contact your doctor when you experience problems such as any chest pain, inability to breathe properly, your heartbeats are irregular, you are experiencing fast heartbeats, or if you feel like you are becoming light-headed. These indicate that you have an abnormal heart murmur. If you think that you are exhibiting symptoms of a heart murmur or if your child is exhibiting signs of a heart murmur, it is best to make an appointment with your doctor. Your doctor will confirm whether the heart murmur is normal or if you need any treatment in the cause of an abnormal heart murmur.

Q.   How should I prepare for an appointment with my doctor?

1. Your doctor is going to ask you specific questions with regards to your symptoms and about your lifestyle. You should be ready to answer these questions in detail because your doctor will be better able to tell you about risks and what changes you need to make. You can write down questions you wish to ask your doctor, and you can write down specific details about your symptoms. If you experience any health problems suddenly then you should tell your doctor about it too. You can ask your doctor about how you can manage your conditions if any and any follow-up care that you need to know about. Take your time and ask all the questions.

Q.   What are the complications that may occur with a heart murmur?

1. There are no complications associated with an innocent heart murmur. However, certain complications that can arise from an abnormal heart murmur are:
• Heart failure. This occurs when the heart has become weak and can’t pump blood very well.
• Blood clots and stroke
• Infective endocarditis or infection of the heart’s valves or inner lining
• Fainting
• Sudden cardiac arrest
• Heart attack

Q.   How common are heart murmurs?

1. Approximately forty to forty-five per cent of children and ten per cent of adults, experience heart murmurs at some point in their lives. A heart murmur can come and go. As it doesn’t produce any noticeable symptoms, people may have a murmur and not know about it.

Q.   Can your heart murmur seriously affect your ability to play sports?

1. Usually, the heart murmurs in athletes are of physiological or innocent types. They are more likely to be a sign of cardiovascular fitness instead of harmful abnormality. As athletes tend to have an intensive exercise regimen, their hearts adapt by becoming slightly enlarged due to which a greater amount of blood can move through with each beat. This stroke volume of blood can cause a gushing noise which is completely harmless and doesn’t affect their ability to play sports in any way.
   
   Rarely, the gushing sound can mean a narrow heart valve or a small hole in the heart. It could also be the result of hypertrophic cardiomyopathy, a condition that causes the heart muscles to thicken and block or reduce the blood flow from the left ventricle to the aorta. Hence, it is important to determine the exact cause due to which the sound is occurring.

Q.   What does heart murmur feel like?

1. A heart murmur typically sounds like a whooshing noise. As the American Heart Association (AHA) mentions it, a heart murmur feels like a very subtle extra pulse. It is commonly seen among young children. Studies and research have shown that almost half of all the children will have innocent heart murmurs at some point, which will fade away as they grow.
   
   Heart murmurs can develop in adults as well, especially when they are fifty years of age or older. Sometimes, they can occur when you have a fever or are pregnant.

Q.  What can a doctor do about your heart murmur?

1. Doctors can identify a murmur during a routine exam and determine whether it is occurring due to a serious underlying condition. They will ask questions to check for symptoms such as shortness of breath, dizziness, or fluid build-up in the lungs and legs.
   
   If your doctor considers it serious, they may refer you to a cardiologist, who will decide which treatment options will work best and whether you need more testing. While no treatment is required for innocent heart murmurs, abnormal murmurs do need medicine or surgery.

Q.   Can anxiety cause a heart murmur?

1. Innocent heart murmurs that are caused due to fever, anxiety or exertion usually disappear after the condition that triggered it goes away. However, heart murmurs that are caused due to congenital heart problems or valve problems will probably last throughout life. In a few cases, they may also worsen over time.

Q.   How do you treat a heart murmur naturally?

1. One can reduce the chances of developing an abnormal heart murmur effectively in the following ways.
• Having a healthy and well-balanced diet is important
• Involving in physical exercise regularly
• Quit smoking or tobacco products
• Limit alcohol consumption
• Existing illness, such as diabetes, high cholesterol, high blood pressure must be kept under control

Q.   What is the difference between a heart murmur and AFib?

1. A heart murmur is caused by the way blood flows through the heart, particularly the valves connecting the chambers of the heart. On the other hand, AFib is associated with the electrical impulses that have turned chaotic and disordered leading to irregularities in the heartbeat rate.