DR. JAYARAM LINGAMANAICKER

MBBS, LRCP (Edin), LRCS (Edin),
LRCP&S (Glas), MRCP (UK),
FRCP (London), FACA (USA),
FAMS (Cardiology), FACC (USA)

Lifeline Heart Centre
#11-10 Mount Elizabeth
Medical Centre
3 Mount Elizabeth
Singapore 228510

Tel: (65) 6836 2611 /
  (65) 6836 9038 /
  (65) 6836 1990

Fax: (65) 6836 9037

E-mail:    

lifelineheart@gmail.com /
lifelineheart@singnet.com.sg



Patient Guide > Heart Murmurs
Patient Guide > Heart Murmurs


Introduction

Heart murmurs are abnormal sounds made by turbulent blood in or near your heart during your heartbeat. Heart murmurs can be present at birth (congenital) or develop later in life. A heart murmurs may indicate an underlying heart problem.

Most heart murmurs are harmless and don't need treatment, these are called functional or "innocent" murmurs. A person with an innocent murmur has a normal heart. Functional heart murmurs are common in newborns and children.

An abnormal heart murmur is usually the result of congenital heart disease or most often due to heart valve problems.

Signs and symptoms

Innocent heart murmur usually has no signs or symptoms.

Frequently the following signs or symptoms are present; they may indicate a heart problem:
  • Skin, finger tip or lips that appears blue

  • Shortness of breath at rest or on minimal exertion

  • Chest pain

  • Dizziness and fainting

  • Swelling of the lower limbs

  • Enlarged liver

  • Engorged neck veins

  • Poor appetite and failure to thrive (in infants)

  • Heavy sweating with minimal or no exertion
Causes of Heart Murmurs

Causes of heart murmurs are many.
  • Innocent heart murmurs

    They occur when blood flows rapidly through the heart such as during physical activity.

    Other conditions that also may cause an innocent murmur. e.g.:

    • Pregnancy

    • Fever

    • Anaemia

    • Hyperthyroidism - excessive production of thyroid hormone in your body

    • Physical exertion

    • Old age when heart valves become thick/stiff

    Over time, most innocent heart murmurs may disappear.

  • Abnormal heart murmurs

    Some congenital and acquired conditions may produce murmurs e.g.:

    • Holes in the heart
      More than half of abnormal murmurs in children are the result of hole in the heart or abnormal connections of blood vessels.

    • Abnormal Valves
      Examples include narrow valves that don't allow enough blood through them or those that don't close properly and leak. For example:

      • Rheumatic fever
        Rheumatic fever is a serious inflammatory condition that can occur when you don't receive prompt or complete treatment for bacterial throat infection. In many cases, rheumatic fever may permanently affect the heart valves and interfere with normal functioning. Prompt and proper treatment of streptococcal throat infection with antibiotics can prevent from progressing to rheumatic fever.

      • Endocarditis
        This is an infection and inflammation of the inner lining of your heart and valves. When bacteria or other germs from another part of your body spread through your bloodstream it usually lodges on your valve producing endocarditis. Left untreated, endocarditis can damage or destroy your heart valves. This condition usually occurs in people who already have abnormal valves and they undergo surgical procedures.

      • Calcified Valves
        This hardening or thickening of valves can occur as you age. These valves may not work as well, resulting in murmurs.
Screening and diagnosis

Screening and diagnosis

Heart murmurs are heard when the doctor listens with a stethoscope, a device that allows them to hear your heart sounds and blood flow.

To determine whether the murmur is innocent or abnormal, your doctor assesses the murmur clinically and also looks for other signs and symptoms of heart problems. Then orders some additional tests if the murmur is suspected to be abnormal.

Additional tests
  • Chest X-ray
    A chest X-ray shows a picture of your heart, lungs and blood vessels. It can reveal if your heart is enlarged.

  • Electrocardiogram (ECG)
    An ECG tracing of your heart could detect irregularities in your heart's rhythm, enlargement of the heart chambers which may be a result of a tight or leaky valve.

  • Echocardiogram
    This ultrasound exam shows detailed images of your heart's structure and function. This test identifies abnormal heart valves, such as those that are calcified or leaking, and can also detect most congenital heart defects. This test is painless. In some cases you may need a transesophageal ultrasound, where a flexible tube is swallowed and pictures are taken. Since the esophagus passes close to your heart, the transesophageal transducer can often produce better images than do sound waves transmitted through your chest.

  • Cardiac catheterization
    In this test, a short tube called a sheath is inserted into a vein or artery at the top of your leg (groin) or into your arm. A long, thin, flexible plastic tube (catheter) is inserted selectively into your heart. The pressures in your heart chambers can be measured, and dye can be injected. The dye can be seen on an X-ray, which helps your doctor see the blood flow through your heart, blood vessels and valves to check for abnormalities.
Treatment

An innocent heart murmur generally doesn't require treatment because the heart is normal.

If you have abnormal heart murmurs, treatment is often not necessary. Your doctor may want to monitor the condition over time. If treatment is necessary, it depends on what heart problem is causing your murmurs and may include medications or surgery.

Medications

Medication prescribed depends on the specific heart problem you have.
  • Prevent blood clots

  • Help your heart contract better

  • Remove excess fluid from your body

  • Lower your blood pressure
Surgery

Surgical options also depend on your specific heart problem but may include:
  • Fixing a valve

  • Reparing a faulty valve

  • Patching a hole in your heart

  • Reconstruct a blood vessel

  • Widening a narrowed blood vessel