Heart Murmurs – Diagnosis and Treatment
Diagnosis
Health care providers check for heart murmurs by performing a careful heart check-up and asking about any symptoms like chest pain, shortness of breath, swelling, palpitations, cough, or feeling tired.
They may also ask about poor feeding or failure to thrive, especially in infants. Family history of heart problems or congenital heart disease is also important.
Providers use a stethoscope to listen to the sounds in the chest. When listening, they note details such as:
- How loud the murmur is (graded 1 to 6)
- Where the sound is heard best and where it travels
- Whether the sound is high-pitched, medium, or low
- When it happens during the heartโs pumping (systolic murmur), when it is relaxing (diastolic murmur), or if it is continuous
- Whether movement or position changes affect the murmur
By listening and gathering this information, providers can usually tell if a murmur is innocent (harmless) or may point to conditions like heart valve disease, endocarditis, congenital heart defect, patent ductus arteriosus, or heart failure.
Sometimes unusual blood flow from valve abnormalities, regurgitation, stenosis, septal defects, or hypertrophic cardiomyopathy may also cause pathologic murmurs.
Medical Tests for Heart Murmurs
If the murmur sounds abnormal or is linked to symptoms, doctors may order more tests to find the cause. Here is a table showing the main types of tests:
| Test Name | What It Does |
|---|---|
| Echocardiogram | Uses sound waves to create pictures of the heart and valves; shows blood flow. |
| Chest X-ray | Takes a picture of the heart and lungs; checks for heart enlargement. |
| Electrocardiogram | Measures electrical activity of the heart; looks for unusual patterns. |
| Cardiac catheterization | Uses a thin tube and dye to see inside the heart and vessels. |
- Echocardiogram provides images of heart defects, valve problems, and abnormal blood flow. It helps spot congenital anomalies, septal defects, and valve disease.
- Chest X-rays reveal changes in heart size from heart defects or heart failure.
- Electrocardiogram (ECG or EKG) checks for arrhythmias or changes that might indicate valve disease, cardiomyopathy, or other heart problems.
- Cardiac catheterization gives a closer look at the inside of the heart and any possible blockages when other tests do not find a clear answer.
Doctors use the results of these tests, along with symptoms and heart sounds, to decide if treatment is needed or if the murmur is harmless.
Innocent heart murmurs, often found in children or during a fever or anemia, usually do not need any treatment.
Treatment
Medicines Used for Heart Murmurs
Doctors may prescribe medicines to address issues linked to heart murmurs. The type of medicine depends on the specific heart problem causing the murmur.
This table shows some of the common medication types and their purpose:
| Medicine Type | Main Purpose |
|---|---|
| Blood Thinners | Help avoid blood clots, lower risk of stroke |
| Water Pills (Diuretics) | Reduce extra fluid in the body; lower blood pressure |
| ACE Inhibitors | Make blood vessels relax and lower blood pressure |
| Beta Blockers | Slow the heartbeat and decrease blood pressure |
In the past, some people took antibiotics before certain surgeries or dental visits to prevent heart infections.
Now, doctors only recommend antibiotics in special situations, such as when someone has an artificial heart valve or a strong risk of infection. Routine antibiotic use is not advised for most people with heart murmurs.
Operations and Other Procedures to Repair Heart Problems
If a heart defect or a valve problem cannot be managed with medicine, doctors may recommend a procedure or surgery.
The goal is to fix the part of the heart that is not working right. Some ways doctors fix these issues include:
- Patching up holes in abnormal heart valves.
- Separating valve parts that are stuck together.
- Putting in new supporting cords for a valve.
- Taking away extra tissue so the valve shuts tightly.
- Wrapping or tightening the area around a valve to make it stronger.
Different methods for these repairs include:
- Open-chest surgery.
- Less invasive surgeries with smaller cuts.
- Using robotic tools for better precision.
- Specialized methods with thin tubes (catheters) that go in through the blood vessels instead of opening the chest.
Surgeons and heart doctors work together with each patient to plan the safest and most effective treatment.
Getting Ready for Your Visit
Steps You Can Take Before the Appointment
Being prepared can help make the most of your time with the healthcare provider. Here are some useful things to do:
- Check for special instructions. Sometimes, tests like an echocardiogram may require not eating or drinking for a few hours. Ask the clinic staff if you need to do anything before your appointment.
- Write down all symptoms. Even minor changes or symptoms that do not seem related to a heart murmur should be listed. For example: fatigue, chest pain, or trouble breathing.
- Gather family health details. Note any relatives with heart conditions, high blood pressure, diabetes, genetic disorders, overactive thyroid, or history of stroke. This helps providers, including pediatric cardiologists or cardiologists, see if heart murmurs might run in the family.
- Make a medication list. Include all medicines, vitamins, and supplements you take, along with dosages. This information supports safe and effective care.
- Bring a support person. Sometimes having a friend or family member along can be helpful. They can listen, take notes, or offer support if you are nervous.
- Think about lifestyle habits. Be ready to talk honestly about exercise, diet, and any challenges with healthy living. Doctors may offer helpful prevention tips or referrals to specialists like those in pediatric cardiology.
Questions to Consider Asking
Carrying a list of questions helps keep the visit focused. Here are some common ones to consider:
| Topic | Example Question |
|---|---|
| Cause | What is the most likely cause of this heart murmur? |
| Diagnosis | What tests will be needed? |
| Specialist Care | Should I see a pediatric cardiologist or another specialist? |
| Management | What are the treatment options and preventive steps? |
| Lifestyle Changes | Are there diet or exercise guidelines I should follow? |
Other Preparation Tips
- Write down any big life changes or stresses that might be affecting health.
- Record any past illnesses, like rheumatic fever, that may relate to the heart.
- Be honest about personal health habits, even those that might seem unrelated.
What the Provider Might Ask and Discuss
The healthcare provider will likely have several questions. Preparing answers ahead of time makes the visit smoother and speeds up care.
Typical Topics the Doctor May Cover:
- Describe your symptoms: type, start date, how often they happen, and severity.
- Explain any changes in daily activity: if exercise or other tasks have become harder.
- Identify triggers: whether anything, like physical activity or stress, makes symptoms worse or better.
- Share your medical and family history: including past heart problems, genetic issues, or an overactive thyroid.
- List any medications you use, or personal habits such as medicine or drug use.
- If the patient is a child, a pediatric cardiologist may ask about prenatal history and growth.
- Discuss any previous occurrences of fever, such as rheumatic fever, that might have affected the heart.
The provider may also ask about other family members’ heart health, including valve problems. This information helps guide whether to refer to a specialist or order more tests.
Doctors may recommend that a cardiologist or a pediatric cardiologist evaluate the patient if the patient is young.
