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Heart murmurs may indicate undiscovered valve problems.

These extra heartbeats are usually noticed only when your doctor listens to your heart with a stethoscope. But they could reveal trouble ahead.

You may have heard the term "heart murmur" and assumed the worst. Is that murmur whispering something serious about your heart health?

In some cases, yes. It may be the first indication that there is something wrong with one of your valves or some other part of the heart's structure. A murmur is an unusual sound heard in between heartbeats. It's the sound of blood flowing in the heart, sometimes through a valve that doesn't open or close properly. But there are other possible causes, too.

"A heart murmur can be a sign of underlying valve or structural heart disease, such as congenital heart disease--a hole in the heart or other complication," explains Cleveland Clinic cardiologist and heart imaging specialist Christine Jellis, MD. "Sometimes it can be a reflection of increased flow across a valve caused by other non-cardiac conditions, such as anemia or thyroid disease." Treatment, if any is necessary, will depend on the cause of the murmur, as well as its location and size.

Diagnosing a Murmur

A heart murmur is usually detected when the doctor listens to the heart with a stethoscope, Dr. Jellis says.

It could be suspected if you have valve disease symptoms, for example. Or, as is often the case, the discovery is a surprise. If you suspect there is something not right about your heart rate, bring it to your doctor's attention.

"Once a murmur is heard, the doctor will consider specific features about the murmur and look for other examination findings to establish a probable cause for the murmur," Dr. Jellis says.


"An echocardiogram (also known as a cardiac ultrasound) is usually done to confirm the cause of the murmur and look for underlying cardiac structural disease," Dr. Jellis says.

She adds that the echocardiogram should, if possible, be done at a good center for cardiovascular imaging. "Ideally, serial imaging should be performed in the same center so that interval changes in heart/valvular disease can be appreciated over time," Dr. Jellis says. "There are multiple features on an echocardiogram that need to be taken into account when evaluating valvular and other structural cardiac disease as a cause of a murmur."

If the murmur is caused by a structural issue, then the doctor needs to establish the severity of the disease. "If it is not severe, and it is reasonable to monitor the person, then serial echocardiograms are performed to watch for disease progression," Dr. Jellis says. "The timing of repeat echocardiograms varies depending on the severity of the condition, but is usually annually for mild to moderate disease."

An echocardiogram is an extremely useful test. It is not painful and does not involve radiation. "It is nothing to worry about and provides us with a 'window' to evaluate your heart non-invasively," Dr. Jellis adds.

Non-Cardiac Causes

"Diagnosis of a murmur is a common occurrence," Dr. Jellis says. "Sometimes during childhood, pregnancy, or other conditions where there is increased flow across the valves (thyroid disease or anemia), the murmur will resolve."

The non-cardiac cause of a heart murmur is typically treated on its own merits, Dr. Jellis says, adding that the murmur usually reduces or resolves on its own. If anemia is the problem, for example, treating the anemia may help make the murmur go away.

"Innocent" heart murmurs are more common in young people.

Kids tend to outgrow them by adulthood. "In childhood there are some small holes in the heart, called septal defects, which spontaneously close over with age," Dr. Jellis says. "Therefore, they might initially present with a murmur, which then goes away. However, in some people the defects or other anomalies can persist and should be followed up to ensure that they don't result in any longer-term complications. Echocardiography is an excellent tool for follow-up of murmurs in both children and adults. It is readily available for a reasonable cost and does not involve any radiation, so repeat echocardiograms are not an issue."

However, a murmur can reflect of underlying structural heart disease and should be further investigated with echocardiography to confirm the cause and what the intervention or follow-up should be.

There are some cardiac conditions that cause murmurs and can be inherited, Dr. Jellis says. These include bicuspid aortic valves (two-leaf aortic valves instead of the normal three-leaf valves) and hypertrophic obstructive cardiomyopathy. "If someone in your family has one of these conditions, your doctor may advocate you having screening with echocardiography to determine if you also have these cardiac abnormalities," Dr. Jellis says.

Caption: A heart murmur is an abnormal sound in between heartbeats, it can be heard with a stethoscope.
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Title Annotation:AWARENESS
Publication:Heart Advisor
Date:Feb 1, 2017
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