A heart murmur is an unexpected or unusual sound that can be heard in your heart through a stethoscope. These sounds, which are similar to a whooshing or swirling, are made by an increase in blood flow. They are unique to the regular ‘lupp-dupp’ noise we hear, which is the sound of your heart valves closing and opening.
Heart murmurs can be present at birth (these are known as congenital heart murmurs), or they can develop later in life. They’re most often ‘innocent’ or harmless, although some are considered ‘abnormal’. The former doesn’t need treatment, as it isn’t a sign of heart disease. The latter, however, requires follow-up tests as it may be a sign of serious underlying heart conditions.
Telling the difference between what’s abnormal and what’s innocent is the tricky part. That’s why we’ve provided a guide to all things heart murmurs below.
What causes a heart murmur?
Generally, a heart murmur may happen when:
- The heart is filling with blood (diastolic murmur)
- The heart is emptying (systolic murmur)
- The heart is beating (continuous murmur)
As there are two types of murmur, there are naturally two sets of causes:
Innocent heart murmurs
Innocent heart murmurs occur when blood flows more rapidly than normal. This is common in newborns and children, and it can sometimes last your entire life. Typically, your doctor will tell you that it’s nothing to be concerned about and instead is just a symptom of a healthy heart.
In fact, your blood flow increases healthily for a number of reasons, including:
- Physical activity
- Phases of rapid growth (such as adolescence)
Abnormal heart murmurs
Unlike innocent murmurs, abnormal murmurs could threaten the health of your heart. In adults, this could mean an acquired heart valve problem. In children, a congenital abnormal murmur is more likely caused by a structural issue in the heart.
Such structural issues include:
- Cardiac shunts
- Problems with the heart valve
- Holes in the heart
Having uncontrolled diabetes or a rubella infection during pregnancy increases a child’s risk of developing heart defects and a heart murmur. The same is true of consuming alcohol, drugs and specific medication during pregnancy.
You can also develop abnormal heart murmurs from certain infections and poor health conditions. For example, valve calcification causes the hardening of valves. These then narrow, making it more difficult for blood to flow through your heart and subsequently causing murmurs.
What are the symptoms of a heart murmur?
There are no symptoms for an innocent heart murmur, but an abnormal one will accompany a number of bodily changes. These include:
- Swelling or sudden weight gain
- Skin that appears blue (especially the fingertips and lips)
- Heavy sweating despite little or no activity
- Enlarged neck veins
- Shortness of breath
- Chronic cough
- Enlarged liver
- Chest pain
Having these symptoms, or an abnormal heart murmur generally, doesn’t necessarily mean you need treatment. That depends entirely on the underlying condition that your heart murmur is connected to.
Your doctor will usually arrange for an echocardiogram if they suspect that your murmur is being caused by a heart problem. Echocardiograms are an ultrasound of the heart and will test if there are any problems with the structure of the organ or with its valves.
If your doctor finds that you do need treatment, your options range from taking medication that controls your symptoms to having heart surgery and fixing the more serious problems. There would need to be a severe issue with one of your heart valves to warrant surgery.
How do I spot a heart murmur in a child?
As innocent murmurs are common in children, it’s important not to rush to conclusions until you’ve spoken with your pediatrician or family doctor. Do stay mindful of the symptoms of abnormal murmurs though, which in addition to the list above include both a lack of appetite and a failure to grow physically.
If you think your child has a heart murmur, then you should absolutely make an appointment to see your family doctor. They’ll be able to identify whether or not it’s innocent and offer you advice if it isn’t.
Prior to visiting your doctor, be sure to find out if you have a family history of heart murmurs or heart rhythm problems. This allows you to rule out certain conditions, and it will help your doctor identify the issue more accurately.
How are heart murmurs treated?
The medication your doctor prescribes would be entirely dependent on the condition you or your family member has. Some medicine they may prescribe includes:
Angiotensin-converting enzyme (ACE) inhibitors – High blood pressure can exacerbate underlying conditions that cause heart murmurs. ACE inhibitors combat this by lowering your blood pressure.
Beta blockers – These drugs lower your heart rate and blood pressure. They're used for certain types of heart valve problems.
Blood thinners – These prevent blood clots from forming in your heart and causing a stroke.
Water pills – Water pills (or diuretics) remove excess fluid from your body, which can help treat other conditions that might make a heart murmur worse, such as high blood pressure.
Statins – These help lower your cholesterol. High cholesterol can aggravate heart valve problems, including some heart murmurs.
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