Heart murmur causes tests and modern treatment methods

Have you ever heard a strange whistling or humming sound in your heart during a medical check-up? This is known as a heart murmur, an abnormal sound caused by the flow of blood through the heart or its valves. While some murmurs are physiological and harmless, others may indicate problems with the heart valves or congenital defects that require monitoring and treatment. In this article, you will learn about the causes of heart murmurs, their symptoms, necessary tests, and modern treatment methods including medication, surgery, and catheterization, so you can protect your heart and maintain your health.

What is a Heart Murmur?

A heart murmur is an abnormal sound caused by blood flowing through the heart or across its valves. This sound is often described as a hum or whistle and is typically heard during a heartbeat using a stethoscope.

Heart murmurs can be physiological and harmless in some cases, while in others, they may indicate a heart problem that requires evaluation and treatment.

A murmur is usually detected during a routine medical check-up with a stethoscope. If the doctor suspects any underlying issues, additional tests such as:

Echocardiogram to image the heart and valves.
Electrocardiogram (ECG) to assess the electrical activity and function of the heart.

Is a Heart Murmur Dangerous?

A heart murmur is not always dangerous:

Innocent Murmurs: These are mild, harmless, and not associated with heart disease.
Pathological Murmurs: These may indicate problems with the heart valves or congenital defects and require medical follow-up.

Does a Murmur Mean There Is Heart Disease?

Not always.

Innocent murmurs are usually harmless.
Pathological murmurs may be a sign of a congenital defect or valve issue.

Can a Child with a Heart Murmur Play Sports?

Innocent murmurs: There are no restrictions, and the child can exercise freely.
Pathological murmurs: It depends on the type of murmur and the heart's condition, and the doctor will recommend a safe exercise program.

How Common Are Heart Murmurs?

Heart murmurs are very common, especially in children. In fact, most people experience innocent heart murmurs in childhood, which typically disappear as the heart grows.

How Loud is a Heart Murmur?

A heart murmur cannot be heard with the naked ear and requires a stethoscope for detection. Doctors classify murmurs based on their intensity using a scale from 1 to 6:

Grade 1: Barely audible even with a stethoscope.
Grade 6: Loud enough to be heard without a stethoscope.

What is the Future of Individuals with a Heart Murmur?

The prognosis depends on the cause of the murmur:

Children: Innocent murmurs typically resolve as the child grows.
Murmurs associated with pregnancy: These usually disappear after childbirth.
Pathological murmurs: These require monitoring and medical treatment depending on the underlying issue.

Do Heart Murmurs Disappear with Age?

Yes, some innocent murmurs in children may resolve spontaneously as they grow.

Are Heart Murmurs Genetic?

Some congenital defects that cause murmurs may have a genetic component. However, most innocent murmurs are not hereditary.

Can a Heart Murmur Be Detected Before Birth?

Yes, heart murmurs can be detected using fetal echocardiography if there is suspicion of a congenital defect.

Do Heart Murmurs Cause Chest Pain?

Innocent murmurs: Typically do not cause any chest pain.
Pathological murmurs: May be associated with chest pain or discomfort if caused by a significant valve issue, such as stenosis or regurgitation.

Exercise for Children with Heart Murmurs

Innocent murmurs: Exercise can be done freely.
Pathological murmurs: The type of activity should be based on the murmur's nature and the heart's condition, and the doctor will suggest an appropriate program.

Risks of Heart Murmurs in Adults

Most pathological murmurs in adults require regular evaluation, especially if symptoms like:

Persistent fatigue
Shortness of breath
Palpitations

Preventing Heart Murmur Complications

Regular follow-up with a cardiologist.
Adherence to prescribed medications.
Prompt treatment of infections to avoid endocarditis.
Healthy lifestyle: regular exercise, avoiding smoking, and monitoring blood pressure.

When is Surgery or Medical Intervention Needed?

Innocent murmurs: No intervention needed.
Pathological murmurs: May require surgery if caused by a damaged valve or a significant congenital defect.

Heart Murmur Tests

Clinical Examination
- Stethoscope: To identify the murmur, its timing, location, and intensity.
- Vital Signs: Blood pressure, heart rate, and oxygen levels.
  The doctor will determine if the murmur is physiological or pathological.
Imaging Tests
- Echocardiogram: The most important test to diagnose the murmur and its cause. It detects congenital defects like VSD or ASD, valve issues, heart chamber sizes, and blood flow.
- Chest X-ray: Assesses heart size and shapes of the ventricles or atria. It can detect heart enlargement or fluid buildup in the lungs.
- Cardiac MRI: Detailed imaging of the heart and valves, especially if echocardiogram or X-ray results are insufficient.
- Cardiac Catheterization: Rarely used, this test clarifies the diagnosis if other tests are unclear. It measures pressure and blood flow in the arteries or heart through a thin tube.
Laboratory Tests
- Blood Tests: Assess heart and kidney function, or detect anemia or infection.
- Cardiac Proteins (BNP or Troponin): Used for heart failure or muscle damage assessment.

Systolic vs Diastolic Murmur

Property	Systolic Murmur	Diastolic Murmur
Timing of the Murmur	During heart contraction (Systole)	During heart relaxation (Diastole)
Common Causes	- Valve stenosis (e.g., aortic or pulmonary stenosis) - Valve regurgitation (e.g., mitral or tricuspid regurgitation)	- Valve regurgitation (e.g., aortic or pulmonary regurgitation) - Valve stenosis (e.g., mitral or pulmonary stenosis)
Sound	Usually a medium to high-pitched hum or whistle	Usually a low-pitched hum or extended whistling
Intensity	From mild to severe depending on the issue	Usually severe if pathological, mild if rare
Examples of Conditions	- Aortic stenosis - Mitral regurgitation - Ventricular septal defect (VSD)	- Aortic regurgitation - Mitral stenosis - Pulmonary valve stenosis or regurgitation

Heart Murmur Complications

Innocent Murmurs
- Usually harmless, no treatment needed.
- Typically resolves with age or rest.
- Does not affect physical activity or daily life.
Pathological Murmurs
The complications depend on the type and severity of the underlying heart condition:

A. Valve Problems
- Valve Regurgitation: Blood flows backward, causing heart strain. May lead to:
  - Heart enlargement or heart failure.
  - Shortness of breath with exertion.
- Valve Stenosis: Difficulty in blood flow, leading to:
  - Heart fatigue.
  - Chest pain or dizziness.
  - Increased risk of fainting or long-term complications.
B. Congenital Defects (e.g., heart holes)
- An abnormal hole between heart chambers causes:
  - Mixing of oxygenated and deoxygenated blood → cyanosis (bluish skin or lips).
  - Increased lung pressure → pulmonary hypertension.
  - Growth delays in children.
C. General Complications of Pathological Murmurs
- Chronic Heart Failure: Due to ongoing pressure on the ventricles.
- Infections: Such as bacterial endocarditis.
- Arrhythmias: Abnormal heart rhythms like palpitations.
- Increased Risk of Blood Clots: Especially with certain valve problems or artificial valves.

Treatment for Heart Murmur

Innocent Murmurs
- Usually no medication is needed, just regular check-ups with a cardiologist.
Pathological Murmurs
The goal of treatment is not to remove the murmur itself but to address the underlying cause or alleviate symptoms:

A. Medications for Heart Failure or Dysfunction
- Diuretics: Reduce fluid retention and swelling.
- ACE Inhibitors: Dilate blood vessels and reduce heart pressure.
- Beta-Blockers: Slow heart rate and alleviate palpitations or fatigue.
B. Medications for Valve Problems
- There are no medications to permanently treat stenosis or regurgitation.
- Anticoagulants: If there is a risk of blood clots.
- Antibiotics: To prevent bacterial endocarditis.
C. Medications for Congenital Defects or Complications
- Medications to treat pulmonary hypertension or secondary heart failure.
- Severe cases may require surgery or catheter intervention if symptoms are severe.

Key Notes:

Medications do not stop the murmur itself if it is caused by a valve defect.
The main goal is to alleviate symptoms, prevent complications, and improve quality of life.
Some cases require ongoing monitoring to determine when surgical intervention is needed.

Treatment for Heart Murmur: Surgery and Laser

The treatment method depends on the type of murmur, its underlying cause, the size of the heart defect, and the patient's overall condition. Treatment can be surgical, catheter-based, or laser-assisted.

1. Traditional Surgical Treatment

Used when the defect is large or cannot be treated with catheter-based methods.

A. Valve Repair Surgery
When to Use:

Severe valve regurgitation (Mitral or Aortic Regurgitation).
Severe valve stenosis.

How It Works:

The valve is either opened or strengthened to improve its function.

Benefits:

Preserves the natural valve.
Improves blood flow and alleviates symptoms.

B. Valve Replacement Surgery
When to Use:

When the valve is too damaged to be repaired.

How It Works:

The damaged valve is removed and replaced with an artificial valve (mechanical or biological).

Benefits:

Provides a permanent solution.

Follow-up:

Mechanical valves require lifelong blood thinners to prevent blood clots.

C. Congenital Defect Correction Surgery
Examples: Repairing VSD (Ventricular Septal Defect) or ASD (Atrial Septal Defect).
The hole is closed using stitches or a patch.
The murmur often improves immediately after surgery.

2. Catheter / Laser / Interventional Treatment

This is a less invasive modern approach used for some valve issues or defects.

A. Balloon Valvuloplasty
Used for widening narrowed valves such as the pulmonary or mitral valve.
A balloon is inserted via a catheter into the valve and inflated to expand it.

Benefits:

Less risky than surgery, with a faster recovery time.

B. Closure of Congenital Defects via Catheter
Used for small or medium-sized VSD or ASD.
A small device is inserted to close the hole in the heart.

Benefits:

The murmur usually disappears immediately after the procedure.

C. Transcatheter Aortic Valve Replacement (TAVR / TAVI)
Used for replacing the aortic valve via catheter without opening the chest.
This is an excellent option for elderly patients or those at high surgical risk.

3. Important Notes

The choice of treatment depends on:

The type of murmur and its cause.
The size of the defect or degree of valve damage.
The patient's age and overall health.

Surgical or catheter-based interventions usually resolve the problem, alleviating pathological murmurs and improving symptoms quickly.

Pre and Post-Operative Care for Heart Murmur Surgery

Before the Procedure

Accurate Medical Follow-up
- Visit the cardiologist to review recent tests (echocardiogram, X-rays, blood tests).
- Inform the doctor about any medications or supplements you are taking.
Stop or Adjust Certain Medications
- Some heart medications or blood thinners may need to be stopped or adjusted before the procedure.
- Always consult your doctor before making any changes.
General Surgical Preparation
- Fast before the procedure as per medical instructions.
- Wear comfortable clothes and arrive on time at the hospital.
- Arrange for transportation post-surgery, as you may not be able to drive immediately.
Psychological and Family Preparation
- Discuss the risks and benefits of the surgery with the medical team to reduce anxiety.
- Arrange for family support after returning home.

After the Procedure

Regular Medical Follow-up
- Visit the cardiologist to evaluate the valve or repair after surgery.
- Follow the doctor’s schedule for echocardiograms or X-rays.
Post-Operative Medications
- Stick to the prescribed medications, such as blood thinners or heart medications.
- Do not stop taking any medication without consulting your doctor.
Healthy Diet
- Reduce fat and salt intake to maintain blood pressure and heart health.
- Eat balanced, light meals to aid recovery.
Rest and Physical Activity
- Rest during the first few days after surgery.
- Engage in light walking as per the doctor’s recommendations to strengthen the heart.
- Avoid heavy exertion or lifting heavy weights in the initial weeks.
Monitor Warning Symptoms
- Severe swelling in the feet or ankles.
- Shortness of breath or chest pain.
- High fever or redness at the surgical site.
  If any of these symptoms occur, contact the doctor immediately.
Care for the Surgical Site
- Keep the wound clean and change dressings as needed.
- Avoid pulling out stitches or directly rubbing the skin.