A heart murmur is a congenital disorder (present from birth) and appears later in life. A sound is produced during a heart murmur due to unstable blood in or near the heart, such as whooshing and swishing. A doctor can hear these sounds with a stethoscope.
A person’s normal heartbeat makes two sounds, “lub-dup,” when closing heart valves. It can be abnormal and harmless. A pure/typical heart murmur is not a sign of any heart disease, and it doesn’t need any treatment. Abnormal heart murmurs need treatment and follow-up testing to determine the cause of murmurs. Treatment is directed according to the cause of the abnormal murmur.
Symptoms of a heart murmur
In an innocent murmur, there are no clear signs and symptoms.
In an abnormal murmur, there are following signs and symptoms occur according to cause;
- Skin appears blue from the fingertips and lips.
- Sudden weight gain.
- Shortness of breath.
- They have enlarged liver/changes in liver size.
- Chronic cough.
- Changes in neck veins/enlarged neck veins.
- In infants, poor growth and development and poor appetite.
- Heavy sweating without any reason.
- Chest pain.
- Rapid heartbeat.
Causes of a heart murmur
A heart murmur can occur when;
- The heart is filling with blood.
- Throughout the heartbeat.
- When the heart is empty.
Causes of heart murmur are different in an innocent heart murmur and an abnormal heart murmur.
Innocent heart murmur
In an innocent heart murmur, the heart is normal. This heart murmur is typical in newborns and children. An innocent heart murmur occurs when blood flows more rapidly than usual by the heart. Conditions that cause more rapidly blood flow through the heart in an innocent heart murmur are;
- Pregnancy
- Fever
- Physical activity
- Exercise
- Having not enough healthy red blood cells which carry sufficient oxygen to the body tissues (anemia)
- Hyperthyroidism (too much thyroid hormone)
- Adolescence (phase of rapid growth and development)
An innocent murmur may last over time without causing any health problems.
Abnormal heart murmur
Abnormal heart murmurs are more often in adults due to the build-up of heart valve problems. In children, an abnormal heart murmur is caused by structural issues of the heart (congenital heart defects).
Common congenital heart defects that cause abnormal heart murmurs;
1. Holes in the heart
It is a septal defect, and holes in the heart may or may not be serious; it relays on the size and location of the heart holes.
2. Cardiac shunts
Cardiac shunts occur due to abnormal blood flow between blood vessels or the heart chambers, the leading cause of heart murmur.
3. Heart valves problems by birth
Valves that don’t allow blood to flow through them, and some don’t close properly and leak (regurgitation)
Sometimes infections and other conditions damage the heart structure, causing abnormal heart murmurs in children and adults. Such as;
1. Valve calcification
As you age, hardening and thickening of the valve occur, as in mitral and aortic valve stenosis. Valves of the heart become narrowed, making blood flow harder through the heart and causing murmurs.
2. Endocarditis
Infections occur in the inner lining of the heart and valves when bacteria spread from one to another part of the body, for example, the mouth; bacteria spread from the mouth to the bloodstream and get stuck in the heart. Left untreated causes endocarditis which can damage heart valves. This condition commonly occurs in people who are already suffering from heart problems.
3. Rheumatic fever
Now it is rare in the United States; it is a severe condition that can occur when people don’t get proper treatment for throat infection. It can permanently affect the heart’s valves and interfere with the normal flow of blood by the heart.
Risk factors
Risk factor increases if someone from your family has a heart defect or heart problem.
Many different conditions can increase the risk of heart murmurs, such as;
- Weak heart muscles
- Infection in the lining of the heart
- Blood disorders such as a high number of specific white blood cells (hypereosinophilic syndrome)
- Autoimmune disorders such as lupus and rheumatoid arthritis
- Rare tumors in the lungs and gastrointestinal system due to chemicals that enter the bloodstream (carcinoid syndrome)
- Heart valve disease
- Hypertension
- Pulmonary hypertension
- Any history of rheumatoid arthritis
- Hyperthyroidism
- Uncontrol diabetes during pregnancy can increase the baby’s risk of developing heart problems.
- Misuse of medications
Diagnosis
During a physical exam, doctors use a stethoscope to listen to the heart. You can do the following steps during the exam;
Tests for detection
If the heart murmur is abnormal, then do some tests, such as;
- Echocardiogram (it is an ultrasound that gives a detailed image of the heart structure and functions and helps to identify abnormal heart valves)
- Chest X-ray (chest X-ray provides a picture of the heart, lungs, and blood vessels)
- Electrocardiogram (ECG) (electrical signals show the detail of heart rhythms and structural problems)
- Cardioid catheterization (in this test, a catheter is passed in your vein or artery of the leg or arm that reaches the heart. A dye can be injected into it.)
Treatment of heart murmurs:
An innocent heart murmur needs no treatment. There is a need to treat fever, overactivity of hormones, and illness in an abnormal heart murmur. Treatment depends/relies on the cause of the heart murmur.
1. Medications:
Several medications are used to treat many heart problems. Some medicines that doctor prescribes include;
- Anticoagulants (blood thinners) prevent blood clotting in the heart and reduce the cause of stroke. Traditional anticoagulants are aspirin, warfarin, etc.
- Diuretics (water pills) remove excess water/fluid from the body and reduce hypertension/high blood pressure that worsens the heart murmur.
- ACE inhibitors (Angio tension-converting enzymes) lower high blood pressure, which causes a heart murmur to worsen.
- Statins reduce high cholesterol. High cholesterol causes heart valves to worsen, an underlying cause of heart murmur.
- Beta-blockers may lower blood pressure and heart rate.
- Doctors recommend using antibiotics before visiting the dentist or surgery to prevent bacteria from spreading.
2. Surgery:
Surgery is required to correct the leaky or damaged valve that causes a heart murmur. Surgery depends on conditions.
Valve repair
The following procedures are done for valve repairing;
Balloon valvuloplasty
During a balloon valvuloplasty, a small catheter with an expandable balloon with thread can pass into the heart, placed into the valve, and then expanded to widen the narrowed valve. It is used to relieve the narrowed valves.
Annuloplasty
In this procedure, the surgeon implants an artificial ring to tighten the tissue around the valve.
Repair of structural support
In this procedure, the surgeons repair the structural support by replacing the support valve cord.
Valve leaflet repair
In this procedure, the surgeon cuts and separates the leaflet.
Valve replacement
Valves have to be replaced in many cases.
Open-heart surgery
It is a primary and severe heart treatment. The surgeon removed the narrowed valves and changed/replaced them with mechanical valves. Metal forming mechanical valves are durable but risk forming blood clots. Tissue valves come from cows, pigs, or deceased human donors.
Ross procedure
It is an autograft valve replacement,
Transcatheter aortic valve replacement (TAVR)
This procedure replaces the valve with a prosthetic valve in a small incision in your leg or chest. In a few cases, a catheter can insert a valve into a tissue-replacing valve (valve-in-valve procedure).
Preparing for an appointment
- Be aware of appointment restrictions.
- Write down the symptoms that are usually experienced.
- Write down essential personal info.
- Make a list of all medications.
- Take a family member.
- Be prepared to discuss.
- Write down questions to ask your doctor.
References
https://www.mayoclinic.org/diseases-conditions/heart-murmurs/symptoms-causes/syc-20373171
https://www.webmd.com/heart-disease/guide/heart-murmur-causes-treatments
https://my.clevelandclinic.org/health/diseases/17083-heart-murmur
