A heart murmur is a sound made by turbulent blood flow in the heart. It sounds like whooshing or swishing with each heartbeat. Some adults and many children have incidental heart murmurs that are benign (harmless) and are not caused by abnormalities in the heart. At least 30% of children may have an innocent heart murmur at some point during childhood. However, some heart murmurs can signal an underlying heart problem.
Benign murmurs are caused by the normal flow of blood through the heart and large vessels near the heart. The murmur may come and go over time. Some things that can increase blood flow and cause a benign heart murmur to be heard include:
Abnormal heart murmurs can be due to:
- Structural abnormalities of the heart valves (most common)—these may be congenital (present from birth) or acquired later in life. Examples include:
- Abnormal holes or connections in the structure of the heart or vessels persisting after birth:
- Structural abnormality of the heart muscle:
- Other congenital heart conditions, such as:
- Endocarditis —infection of the inner lining of heart valves and chambers (endocardium)
- Cardiac myxoma—a benign soft tumor within the heart (rare)
Risk factors for normal heart murmurs include:
- Age: 3-7 years old
Risk factors for abnormal heart murmurs include:
- Rheumatic fever
- High blood pressure
- Autoimmune disease
- Congenital heart defects or disease
Benign heart murmurs usually cause no symptoms. Patients with mitral valve prolapse sometimes complain of vague chest discomfort and other symptoms. It remains unclear whether or not the valvular abnormality is causing the symptoms.
Signs and symptoms of abnormal heart murmurs can include:
- Rapid breathing or trouble breathing
- Blue lips (cyanosis)
- Chest pain
- Palpitations (feeling of rapid or irregular heartbeat)
- Exercise intolerance
- Failure-to-thrive in children
When Should I Call My Doctor?
If you think that you or your child has a heart murmur, you should see the doctor.
Most benign heart murmurs are diagnosed during the course of a routine physical exam with a stethoscope. Some abnormal heart murmurs are also discovered this way. Other abnormal heart murmurs are discovered initially by their symptoms.
Tests may include:
- Electrocardiogram (ECG)—This does not diagnose the cause of the murmur but can provide other useful information about the condition of the heart.
- Chest x-ray —to determine the approximate size and shape of the heart, and the presence of associated lung swelling (pulmonary edema).
- Echocardiogram —to examine the size, shape, and motion of the heart.
- Cardiac catheterization —to detect problems with the heart's structure, function, and blood supply.
- Blood tests—To check for evidence of a recurrent heart attack or other diseases that may affect the heart (such as kidney disease, infections, autoimmune conditions).
Benign heart murmurs require no treatment. Treatment of other heart murmurs depends on the underlying cause and extent of the problem.
Medicines can either treat the cause of the heart abnormality associated with the murmur or help compensate for its dysfunction:
- Diuretics, angiotensin-converting enzyme inhibitors, digitalis—to treat heart failure
- Antibiotics—to prevent or treat endocarditis
Surgery is often necessary to treat severe heart abnormalities:
- Replacement of defective heart valves with artificial ones
- Correction of congenital heart defects
- Removal of heart tumors
Preventing benign heart murmurs is unnecessary. To help reduce your risk of developing an abnormal heart murmur:
- Get prompt testing and treatment for strep throat to prevent rheumatic fever.
- Reduce your risk of atherosclerosis to help prevent valvular heart disease in the distant future. To do this:
Although not routinely recommended for every type of heart murmur, you may need to take antibiotics before and after some medical or dental procedures that could allow bacteria to enter your bloodstream. Ask your doctor if you need to take preventive antibiotics.
- Reviewer: Marcin Chwistek, MD
- Review Date: 09/2013 -
- Update Date: 09/30/2013 -