Heart Murmur

What is a heart murmur?

A heart murmur is an extra swishing or whooshing sound a doctor hears through a stethoscope. Turbulent blood flow in or near the heart makes that sound. A murmur is a sound, not a disease. Normal blood flow is smooth and quiet. Blood becomes turbulent and audible when it speeds up, squeezes through a narrowed valve, or leaks backward through one that does not close. Murmurs are sorted into two groups. Innocent murmurs occur in structurally normal hearts. They are common in children, in pregnancy, with fever, and with anemia or an overactive thyroid. Abnormal murmurs signal a real problem. Most often a valve has stiffened or started to leak. Doctors grade a murmur by loudness and describe when it occurs in the heartbeat. The stethoscope alone cannot settle the question. An ultrasound of the heart is what distinguishes a harmless murmur from valve disease, as the American Heart Association explains.

Symptoms to watch for

Most murmurs cause no symptoms and are found during a routine exam. Symptoms usually mean the underlying valve problem has progressed.

Call the office if you have a known murmur along with:

• Shortness of breath with activity, or when lying flat.
• Swelling in the ankles, feet or abdomen.
• Fatigue or reduced stamina that is new for you.
• Palpitations or a persistently irregular pulse.
• Lightheadedness with exertion
• Unexplained fevers, which can signal an infection of a valve.

Call 911 if you have:

• Fainting, especially during exercise
• Chest pain or pressure lasting more than a few minutes.
• Severe shortness of breath at rest, or waking gasping for air.
• Coughing up pink, frothy sputum.

Fainting during exertion with a known murmur can indicate severe narrowing of the aortic valve. It requires emergency care. The MedlinePlus overview of valve disease describes how these symptoms develop.

How Dr. Nanavati diagnoses it

The exam is the starting point, and ultrasound gives the answer. Dr. Nanavati listens over each valve area. He listens standing and sitting, and uses maneuvers that change how loud a murmur sounds.

• Transthoracic echocardiography is the definitive test. It shows each valve moving in real time. It measures how much blood leaks or how tight a narrowing is, and it reports the pumping strength.
• Echocardiogram studies are performed in the office. They take about 30 minutes and use no radiation.
• Transesophageal echocardiography gives a much closer view. It is used when the standard study is inconclusive or when infection of a valve is suspected.
• Electrocardiogram (ECG or EKG) checks for chamber enlargement and rhythm problems caused by a leaking or narrowed valve.
• Treadmill stress testing measures your true exercise capacity. It helps when symptoms and valve measurements do not match.
• Holter monitoring is added if you also have palpitations or suspected atrial fibrillation, which valve disease can cause.

Treatment options

Many murmurs need nothing more than reassurance and a repeat listen. When a valve problem is confirmed, treatment follows its severity.

Watchful waiting. Mild to moderate valve disease is monitored with echocardiograms at set intervals, often yearly. The purpose is to catch the moment the valve becomes severe. That has to happen before the heart muscle is damaged. Keeping that schedule is the treatment.

Risk factor management. Blood pressure control reduces the load on a leaking valve. Cholesterol treatment guided by advanced lipid testing protects the heart muscle overall. So do the habits in Life's Essential 8. Good dental hygiene lowers the risk of a valve infection.

Medication. Diuretics relieve fluid buildup. Blood pressure medicines reduce strain. Rate control or anticoagulation is added if AFib develops. Medication does not fix a valve. It does manage symptoms and protect the heart.

Repair or replacement. Severe valve disease is treated with surgical repair, surgical replacement, or a catheter based valve procedure. These happen at an affiliated hospital. Dr. Nanavati handles the evaluation, timing and referral, then follows you afterward. Cardiac rehabilitation supports recovery.

What to expect at your visit

Bring the note or report that mentioned the murmur. Also bring your medication list and any previous echocardiogram results for comparison. Your appointment includes a full cardiac exam, blood pressure and an electrocardiogram. If an echocardiogram is ordered, you lie on your left side. A technologist moves a probe over your chest with gel. It is painless and involves no needles. Dr. Nanavati reviews the images with you. He tells you plainly whether the murmur is innocent. If it is not, he tells you which valve is involved and when the next study is due. The FAQs page covers what to bring.

When to see a cardiologist

Get evaluated if a clinician mentions a murmur you have never had checked. Get evaluated if a known murmur sounds louder. The same goes for a murmur that comes with breathlessness, swelling or fainting. Children with murmurs should be assessed, as should adults with a bicuspid aortic valve or a family history of valve disease. So should anyone with an aortic aneurysm. Request an appointment online or call the Bonita office at (619) 585-0476.

Dr. Vimal Nanavati, MD, FACC is board certified in cardiology and interventional cardiology. He has 32 years of experience. He founded Advanced Heart Care, Inc. in 1997. He sees patients at three locations. The Bonita office is in South San Diego. It serves Chula Vista, Eastlake, Otay Ranch, National City, Spring Valley, Imperial Beach, San Ysidro and Coronado. The North San Diego office at 5190 Governor Dr serves University City, La Jolla, Clairemont and Mira Mesa. The Redding office serves Shasta County, Anderson, Red Bluff, Palo Cedro and Cottonwood.

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