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Heart murmurs may indicate valve trouble: as we age, valvular disease becomes more common, but early diagnosis can help keep your heart pumping strong.

When cardiologist Mary Ann McLaughlin, MD, diagnoses heart murmurs in her older patients, they'll often say something like, "Oh, it's nothing. I've always had that."

That may be true. A heart murmur is a noise caused by turbulent blood flow, which could be the result of vigorous blood flow across a normal valve--as in pregnant women, who are pumping a larger volume of blood--or normal flow across a valve which is thickened but works normally. But it also can be a sign of a more serious valve problem. The American Heart Association reports that valve disease is the primary cause of about 20,000 deaths in the U.S. annually.

The two types of valvular disease are: stenosis, or difficulty in opening the valves, often caused by calcium buildup on the valve; and regurgitation or leaky valve, in which the valve does not close properly and blood leaks back in the wrong direction. In both cases, early diagnosis is critical, as valvular disease can lead directly to heart failure.

"If you wait too long to address valvular disease, you can be left with a very weak heart," says Dr. McLaughlin, director of the Cardiac Health Program at Mount Sinai School of Medicine.

Symptoms. The most common symptom of valvular disease is shortness of breath after a brief walk or similar activity. Chest pain and faintness may follow. If you find yourself fatigued after minor exertion, don't hesitate to talk to a doctor.

Likewise, if you have high cholesterol, you may also have calcium buildup on your valves. Ask your doctor about whether an echocardiogram is necessary even if you don't have other symptoms. In addition, older adults who have ever had rheumatic fever should get an echocardiogram to see if their valves were damaged, a common side effect of rheumatic fever.

A heart murmur is fairly easy to recognize with a stethoscope. An echocardiogram, which provides an image of the heart's valves, chambers and blood vessels, can confirm or determine the cause of the murmur.

Treatments. Once you are diagnosed with a valve problem, your doctor may recommend following your condition with echocardiograms at regularly scheduled intervals. Medications such as ACE inhibitors may be prescribed to widen blood vessels and decrease the heart's workload. There are two ongoing studies investigating whether statins, which help lower cholesterol, might also help reduce calcium buildup on the valves.

"Either stenosis or leaky valves can cause enlargement of the heart," Dr. McLaughlin says. "There are some medications that can help keep the heart from becoming enlarged, but sometimes that's just not enough."

If a condition worsens, doctors can repair, or in some cases replace, defective valves.

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Publication:Focus on Healthy Aging
Date:Aug 1, 2007
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