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Question:
How serious is a heart murmur?
At 47 just learned I had a loud heart murmur. How serious is this?
submitted by Becca from Missouri on 2/25/10
Answer:
by Texas Heart Institute cardiologist, Jose G. Diez, MD
A heart murmur is not a disease, it is a physical finding due to turbulence in the normal blood flow. This causes an abnormal sound during each heart beat.
The prognosis and treatment of heart murmurs depends on the type and severity of the heart problem causing them. There are two types of heart murmurs: innocent (harmless) and abnormal. People who have innocent heart murmurs have normal hearts. They usually have no other signs or symptoms of heart problems. Innocent murmurs are common in healthy children. People who have abnormal murmurs may have other signs or symptoms of heart problems. Most abnormal murmurs in children are due to congenital heart defects. These are heart defects that are present at birth. In adults, abnormal murmurs are most often due to heart valve problems caused by infection, cardiovascular disease, or aging.
In general, murmurs can be produced by the following abnormalities:
> Mitral valve prolapse: Normally your mitral valve closes completely when your left ventricle contracts, preventing blood from flowing back into your left atrium. If part of the valve balloons out so that the valve does not close properly, you have mitral valve prolapse.
> Mitral valve or aortic stenosis: Your mitral or aortic valves, both on the left side of your heart, can become narrowed by scarring from infections, such as rheumatic fever, or may be narrow at birth. Such narrowing or constriction is called stenosis.
> Aortic sclerosis: a heart murmur due to the scarring, thickening, or stiffening (sclerosis) of the aortic valve. Aortic sclerosis is usually seen in elderly people with atherosclerosis, or hardening of the arteries.
> Mitral or aortic regurgitation: Regurgitation (backward flow) of blood can occur with mitral valve prolapse or mitral valve or aortic stenosis. To counteract this back flow, the heart must work harder to force blood through the damaged valve. Over time, this can weaken and/or enlarge the heart and can lead to heart failure.
> Congenital heart defects: such as holes in heart walls or misshapen heart valves. Many congenital heart defects can be corrected by surgery or percutaneous procedures (plugs, valvuloplasties).
> Some common conditions can force your heart to beat faster, changing the rate and amount of blood moving through your heart and resulting in heart murmurs. These conditions include: pregnancy, anemia, high blood pressure, overactive thyroid or fever.
Heart murmurs can be detected during a physical exam. The physical exam would guide what type of defect / anomaly is present and suggest what would be the best confirmatory tests. Your doctor may order one or more of the following tests to see whether your heart murmur is innocent or whether it is caused by acquired valve disease or a congenital defect:
> Electrocardiogram (ECG), which measures the electrical activity of the heart
> Chest X-rays to see if the heart is enlarged due to heart or valve disease
> Echocardiography, using ultrasound, the heart and its structures can be visualized and the severity of the defects or anomalies quantified.
> Cardiac catheterization, using X-rays and contrast agents the defects can be visualized and quantified. Using pressure measurements the impact of the abnormality can be evaluated. Can also allow for percutaneous therapies depending of the type of defect (e.g, valvuloplasty, defect closure)
> Cardiac MRI, using magnetic fields (no radiation) and special contrast agents, it can provide very detailed anatomic and functional information.
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Updated March 2010
