Heart Murmur: Symptoms and Causes

What does a heart murur sound like? Your heart makes a lub-dub sound as it pumps blood to your body. These sounds are caused due to the closure of the valves in the heart. The lub sound is cause due to the closing of the valve between the atrium and the ventricles; while the dub sound is caused due to the closure of the valve between the ventricle and the outgoing artery. Sometimes the heart sounds include other notes called clicks, snaps and murmurs; these sounds are generally a sound of an abnormality in the heart (in some cases they may be present in a normal individual also). The murmurs in the heart are the ‘whoosh’ or ‘swish’ heard with the stethoscope, along with the normal lub-dub.

What Causes a Heart Murmur

The murmurs in the heart are the ‘whoosh’ or ‘swish’ heard with the stethoscope, along with the normal lub-dub. The murmurs may be present in healthy individuals but in most they are a sign of an underlying disease.

Normal individuals with a heart murmur are generally the ones with an increased blood flow through their heart like:

• Pregnant women
• Anaemic individuals
• After exercise
• Hyperthyroidism

Unwell individuals may have a murmur due to:

• Congenital abnormality in the heart: a defect in the heart which is present since birth like Atrial septal defect, Ventricular septal defect, Patent ductus Arteriosus
• Narrowing of a valve
• Regurgitation through a valve
• Calcification of the valves: leading to narrowing of the valve
• Infection of the valves: leading to prolapse or regurgitation
• Rheumatic heart disease: most commonly causes narrowing of mitral valve.

Heart Murmur  Symptoms

Most individuals discover a heart murmur during a routine physical check up, i.e. most individuals are asymptomatic. Children born with heart defects may manifest the symptoms depending upon the location and size of the defects. 

Some of the common symptoms seen in experienced by individuals with heart murmur are:

• Shortness of breath
• Swelling in feet or ankle
• Chest pain
• Cyanosis: blue discoloration of lips and finger tips
• Sudden weight gain due to fluid retention
• Spells of dizziness
• Engorgement of veins in the neck
• Cough with or without blood in the expectorate
• In infants, failure to thrive

Heart Murmur Diagnosis

Your cardiologist will like to do a thorough examination of your chest to look for signs of a murmur. To confirm the diagnosis your doctor might advise you to undergo some tests like:

• Echocardiogram: for this test a small hand held probe will be put on your chest by the doctor; this probe produces sound waves which help in visualising the heart with its chambers and valves. This test also helps the doctor evaluate the flow of blood through the chambers. Severity of the murmur can be assessed by this test.
• Chest X ray: to assess the position and size of your heart
• Electrocardiogram: small leads will be placed on your chest to record the electrical activity of the heart. The reading of an electrocardiogram tells your doctor about the rate and rhythm of your heart in addition to the health of the different chambers of your heart.

Complications of Heart Murmur

The complications caused by heart murmur depend on its cause and severity and duration. They include:

• Pulmonary hypertension
• Heart failure
• Atrial fibrillation
• Increased incidence of stroke or TIA
• Cardiomegaly
• Enlargement of liver
• Failure to thrive in new born

Heart Murmur Treatment

The treatment for a heart murmur depends on the severity of the symptoms it causes. Murmurs in healthy people need not be treated unless there is an indication that says otherwise.

Medical treatment

Alleviating the symptoms and preventing further complications is the goal of this mode of treatment

• Anti arrhythmic drugs: prevent irregular heart beats
• Beta blockers and ACE inhibitors: these drugs help controlling your blood pressure.
• Anti coagulant: also known as blood thinners they reduce the chances of formation of blood clots.
• Diuretics: agents which help reduce the load on the heart by causing an increase in excretion of water by urine.

Surgical treatment

Repair of the defect is the goal of this mode of treatment.

• Valve repair: an open heart surgery is performed by the cardiologist to repair the damaged valve or the structure on which the valve is present(annuloplasty)
• Percutaneous balloon valvuloplasty: a small tube is inserted into the artery in your groin of arm and guided to the heart. When it reaches the valve a balloon is inflated to breakdown the commissure between the valves which were causing the narrowing.
• Valve replacement: the damaged valve is replaced by a biological or mechanical valve in an open heart surgery
• Transcatheter aortic valve replacement (TAVR): a small tube is inserted into your aorta via an artery in your groin or a small incision in your chest. The damaged aortic valve is replaced by a prosthetic valve.

Individuals with prosthetic valves are required to take anti coagulants for a long time to prevent formation of clots. The biological valve degrade with time, hence they need to be replaced over the period of few years.

Resources:

• American Heart Association. www.heart.org
• http://www.acc.org/guidelines