An Overview of Heart Murmurs

A heart murmur is an extra or abnormal sound that is heard during cardiac auscultation (when your healthcare provider listens to your heart with a stethoscope).

A murmur doesn't cause noticeable effects on its own. Certain heart murmurs are completely harmless and are not associated with any health problems at all. But sometimes a heart murmur is a sign of heart disease, and you may experience fatigue, shortness of breath, or other complications of your heart condition.

If a murmur is detected, the cause can usually be identified with a non-invasive test. If there is a serious cause of your heart murmur, surgical or medical treatment can often correct the problem and prevent complications.

Symptoms

Heart murmurs affect people of all ages, ranging from newborns to elderly adults. A heart murmur can begin at any age, and it may change throughout a person's life.

Many heart murmurs, called "innocent" murmurs, are not associated with any underlying heart problems. They are simply sounds made by the normal flow of blood through the heart. Other murmurs, called "abnormal" murmurs, are associated with heart problems that could cause serious health issues if they are not treated.

If you have heart disease that causes a murmur, some symptoms you may notice include:

• Fatigue, low energy
• Chest pain
• Occasional lightheadedness or dizziness
• Shortness of breath, especially with physical exertion
• Palpitations (a sense that you have a rapid or irregular heartbeat)

Congenital Heart Conditions

Sometimes, children are born with heart problems. These conditions may cause serious effects right at birth or during childhood. Babies who have a heart murmur may have bluish skin, especially on the fingers or lips. This is often a medical emergency.

Children who have mild heart conditions may have less than expected weight gain and can be shorter than their expected height. They may have exercise intolerance—or may complain that they don't like sports or gym class.

Causes

Normally, the heart contracts and expands with a regular rhythm that produces sounds described as "lub dub." These sounds can be heard with a stethoscope.

As the heart beats, its valves open and close in sequence to let the blood flow through the heart's chambers. Sometimes turbulence is produced by the flow of blood across the valves. The turbulence can be heard as a murmur when the doctor listens to your chest with a stethoscope. Abnormal heart murmurs can be produced by a variety of heart diseases.

The most common causes of heart murmurs differ depending on a person's age:

• Older adults: Abnormal murmurs are most common among adults over the age of 60. They can be caused by a heart valve problem, such as prolapse, stenosis, or regurgitation. Other issues, such as endocarditis (a heart infection), arrhythmias (abnormal heart rhythm), or complications from a previous heart attack can cause a murmur as well.
• Babies and children: A murmur may be the result of a congenital heart defect, such as Tetralogy of Fallot and sepal defects.
• Young adults: A murmur could be due to a structural problem that was not diagnosed in childhood, or it could develop due to a heart condition that was acquired later in life, such as the conditions that cause heart murmurs in older adults. The most common types of murmurs in young adults are innocent murmurs, also known as flow murmurs, which are entirely normal.
• Pregnant women: It is not common to develop serious heart disease during pregnancy. Pregnancy may cause a murmur that is often described as an "innocent murmur." This is believed to occur due to increased blood volume flowing through the blood vessels—which places extra work on the mother's heart.

Diagnosis

Your healthcare provider, and possibly a cardiologist (a specialized heart doctor) may detect a heart murmur during your routine medical examination. It can be louder or last a bit longer than your other heart sounds. Sometimes heart murmurs are quiet and may not be easy to hear, or they can come and go.

Your healthcare provider may be able to determine the cause of your heart murmur by listening to your heart sounds with a stethoscope, and additional tests are usually necessary to assess your heart structure and function.

Diagnostic Tests

There are several tests that can be used to assess the structure and function of your heart. You may have one or more of these as your medical team evaluates the cause of your heart murmur.

• Electrocardiogram (ECG): An ECG is a non-invasive test that is used to assess heart rhythm. You would have leads (flat metal plates attached to wires) placed on your chest to produce a tracing that reflects your heart rhythm.
• Echocardiogram: An echocardiogram, often referred to as an echo, is a non-invasive ultrasound of the heart. You would have a small device placed on your chest, which produces a video of your heart in action. Your heart rhythm and its anatomical structure (including the valves) can be evaluated using this test.
• Cardiac catheterization: This is an interventional diagnostic test that allows your medical team to look inside your heart. During this procedure, a wire (sometimes with a camera) is placed into a blood vessel (usually in the arm or groin) and threaded up into the heart. Detailed information about the valves, blood vessels, and blood pressure can be obtained using this test.
• Cardiac magnetic resonance imaging (MRI): Magnetic resonance imaging allows healthcare providers to view the structure of the heart in detail. This form of imaging is noninvasive and has no known side effects, though it may not be appropriate for people with any form of metal implant, such as a pacemaker.
• Cardiac computed tomography (CT): This form of imaging uses multiple x-rays to create a three-dimensional image of internal organs and structures.

In most cases, the cause of a heart murmur is diagnosed with a non-invasive echocardiogram.

Treatment

Some heart murmurs are caused by conditions that require surgical treatment and/or require medical management, while some do not require any intervention at all.

If you have a heart condition that does not require immediate treatment, your medical team will periodically assess your heart function.

Surgery

In some situations, emergency surgery may be necessary. Babies born with severe congenital heart defects may require repair. And some anatomical defects have to be repaired in stages, with several surgeries. Some children may have to wait until they are physically bigger before having a heart defect repaired.

Heart surgery for children and adults can involve open-heart surgery, in which the chest is opened for the procedure. In some instances, a minimally invasive procedure that uses a catheter is used to repair the heart.

Medical Management

There are some medical approaches for treating heart problems that cause murmurs.

An arrhythmia can often be treated with prescription medication. In some cases, this corrects the heart murmur.

Sometimes medications are used to prevent complications, but cannot treat the underlying problem. For example, some people who have valve disease or arrhythmias may need to use a blood thinner to prevent blood clots.

A Word From Verywell

Heart sounds can change throughout the lifespan. A murmur that is present in childhood may resolve as the child grows into an adult. An adult may develop a murmur, which may be a sign of a problem with the heart.

It is important to remember that many people have heart murmurs and live long and healthy lives with no need for treatment at all.