Heart murmur: a cause for concern? | Top Doctors

Upon hearing the term heart murmur, some people may feel immediate panic. However, a heart murmur is not always a cause for concern. Consultant cardiologist Dr Marco Spartera sheds light on this topic building on his experience of leading a high-volume valve clinic service.

What is a heart murmur?

A heart murmur is an abnormal sound heard during a cardiac examination. The normal heart flow through one’s heart is typically smooth and does not produce any audible murmur (similar to a smooth river flow which is peaceful and quiet, see picture). When a murmur is heard, this typically reflects a turbulent (i.e. the opposite of smooth) blood flow through the heart and blood vessels, similar to an obstructed noisy river flow. 

Heart murmurs can be harmless (‘innocent murmurs’) as in the case of a particularly vigorous pump function. However, in some cases, murmurs may be a sign of an underlying heart problem, such as a defective heart valve (see picture of a leaky aortic valve), or an obstruction to flow underneath the heart valves, or other cardiac conditions.

What are the symptoms of a significant or concerning heart murmur?

In some cases, a heart murmur may not have any associated symptoms. However, it can also be an early sign of future cardiology symptoms such as shortness of breath, chest pain, palpitations, dizzy spells, blackouts and fainting.

How are heart murmurs detected and diagnosed?

Heart murmurs are usually detected during a cardiac examination, typically through a stethoscope. It is usually necessary to perform cardiac imaging tests, such as an echocardiogram (sometimes through the gullet, also called transoesophageal echocardiogram i.e. TOE) and/or cardiac MRI in order to determine the cause and any associated symptoms.

Such imaging tests will uncover problems such as a narrowing or a leak of one of the four main heart valves, as well as determining their degree (mild vs moderate vs severe).

Are heart murmurs hereditary, and should family members be concerned?

Some heart murmurs may be linked to valve disease where there is a genetic risk component. For instance, some conditions including bicuspid aortic valve can be transmitted in families. Therefore, first-degree relatives of someone with a bicuspid aortic valve should be checked for the condition.

What are the treatment options for heart murmurs?

The most important step in establishing a plan and treatment is to identify the precise nature of the murmur. If a valve disease is detected, it is essential to understand the underpinning mechanism (leak versus narrowing; severity of the leak/narrowing; root cause of the valve disease including calcific degeneration, redundant tissue, prolapse, etc). Based on this imaging assessment, it is possible to explore therapeutic options including traditional surgery to repair or replace native valves or keyhole procedures.

If you would like to book a consultation with Dr Spartera, do not hesitate to do so by visiting his Top Doctors profile today.