Heart murmur facts
What is a heart murmur?
A heart murmur is a continuous sound that is audible with a common stethoscope, produced when blood passes through particular areas of the heart. The heart has four chambers, two atria (singular = atrium) and two ventricles separated by a "skeleton" of cartilage that separates each chamber. This skeleton is made up of the atrial septum, the ventricular septum, and four valves (aortic, pulmonary, mitral, and tricuspid) that direct blood flow in a specific route within the heart allowing the most efficient use of each heartbeat to pump blood to the rest of the body.
How the heart worksThe sound of a murmur is generated when blood flow within the heart is not smooth and turbulence occurs. Using a stethoscope, a health care practitioner may be able to hear a heart murmur during the physical examination. Of note, not all heart murmurs are abnormal or dangerous, but if one is present it may signal a structural abnormality of the heart.
Picture of the heart and heart valves.What causes a heart murmur?
Functional heart murmurMany heart murmurs are harmless and referred to as innocent or functional. They are caused when blood rushes through the heart quickly during normal function while no heart disease may exist. There may be an underlying medical condition that can lead to an innocent murmur. These may include situations where the heart beats more quickly such as fever, anemia, hyperthyroidism, and pregnancy.
Congenital heart murmursCongenital heart murmurs are heard in the newborn. They may be due to abnormalities in the valves, septae, or arteries, and veins that carry blood to and from the heart. In some complicated heart disease conditions there may be a combination of all three. Many congenital heart murmurs resolve spontaneously without medical intervention while others require surgical operations for repair.
Patent ductus arteriosus (PDA) may cause a heart murmur in a newborn. Prior to birth, the aorta and pulmonary artery are connected by a small artery, the ductus arteriosus, to complete fetal blood circulation. Shortly after birth, this artery is supposed to close. If other congenital heart abnormalities exist, the ductus may remain open to help maintain some blood circulation. Sometimes, when no congenital abnormalities exist, the ductus doesn't completely close and a murmur may exist. Many times the patent ductus arteriosus closes by itself over time. Occasionally, medications or surgery may be required to close off the patent ductus arteriosus.
Valve abnormalitiesAbnormalities of the valves of the heart may cause a heart murmur. Any of the heart valves may be affected and clinical symptoms depend upon the severity of the valve damage and whether the blood flow pattern within the heart is maintained. Each valve problem often leads to a specific character and timing of heart murmur.
Holes in the walls of the heart (the septum that divides the heart chambers) can be the source of a heart murmur. Atrial septal defect (ASD) describes a hole in the wall that separates the collecting chamber of the heart while a ventricular septal defect (VSD) affects the wall dividing the pumping chamber.
What are the risk factors for heart murmur?
A heart murmur is a physical finding of an underlying heart condition and in many instances may be of no consequence. The risk factor for developing a particular murmur is the risk factor for the underlying condition.
Congenital heart disease tends to have a familial basis, meaning that there may be a genetic predisposition for a baby to develop a structurally abnormal heart.
Some valvular diseases are present at birth, but take a lifetime to develop symptoms. For example, the aortic valve is supposed to have three leaflets that come together; some people are born with a valve that has only two leaflets (bicuspid). Over time, a two-leafed valve may be more prone to calcification and narrowing. Symptoms may only be seen later in life.
Some valve diseases are due to infection and past rheumatic fever with heart valve inflammation due to a bacterial streptococcus infection. With present day screening for strep infections and the appropriate use of antibiotics, this risk factor has decreased significantly.
Other risk factors for heart valve abnormalities include atherosclerotic heart disease, heart attack, aortic aneurysm, and connective tissue disorders such as systemic lupus erythematosus and Marfan syndrome. Each condition affects the valves in a different way causing them to malfunction and develop the physical finding of a heart murmur.
What are the symptoms of a heart murmur?
A heart murmur in itself causes no symptoms and it generally cannot be heard by the person affected. It is the underlying structural issue of the heart that may cause problems. Note that many heart murmurs are of no consequence.
Congenital heart disease may present with newborns who have difficulty breathing and who are cyanotic, meaning that the heart cannot circulate blood and oxygen from the lungs to the body. Some infants with heart issues may have difficulty feeding, developing, and growing appropriately.
Most heart murmurs in well-developed children are harmless.
In adults, heart abnormalities may cause chest pain, shortness of breath, and swelling of the extremities among many other symptoms.
Palpitations or a sensation of an irregular heartbeat are occasionally seen in patients with heart valve abnormalities.
When should I seek medical care for a heart murmur?
A heart murmur generally does not cause any symptoms. It is the underlying heart function issues that often cause patients to seek medical help.
Chest pain and shortness of breath should always be taken seriously and not ignored. Medical help should be accessed immediately if a person has heart or lung concerns.
How is a heart murmur diagnosed?
A heart murmur is usually diagnosed during a physical examination by the health care practitioner while he or she listens to heart sounds with a stethoscope.
Patient historyEvaluation of the heart begins with questions relating to heart function. In an adult, some questions may include asking about chest pain or pressure, shortness of breath with exertion or at rest, and swelling of the legs. In an infant, the symptoms may include poor sucking or eating, poor weight gain and growth, or episodes of turning blue.
Physical examinationPhysical examination includes assessing skin color, feeling and assessing pulses, evaluating the legs looking for swelling and edema, and listening to the lungs for signs of fluid buildup.
Heart evaluation includes assessing the rate and rhythm of the heart. Is it too fast, too slow, regular, or irregular? The front of the chest can be palpated; a hand is placed on the area overlying the heart trying to feel for a vibration that can occur with an especially significant heart murmur.
Listening to the heart with the stethoscope begins with assessing basic first and second heart sounds, S1 and S2, which sound like "lub-dup." Potential extra heart sounds are referred to as S3 and S4. Should a heart murmur be heard, the health care practitioner will try to determine whether the sound is coming from an abnormal valve or a defect in the atrial or ventricular septum. The murmur is described whether it is heard in systole (when the heart is pumping) or diastole (when the heart is filling). The location on the chest and where the sound radiates is important in determining where the murmur originates. The intensity of the murmur is usually graded on a 6 point scale as follows:
Murmurs graded 4, 5, and 6 have an associated vibration (thrill) felt when the chest wall is palpated:
Many murmurs are diagnosed as normal (physiologic) based upon physical examination and require no further evaluation.
Initial testing may include an electrocardiogram (EKG) which can help evaluate the heart rate and rhythm, electrical conduction within the heart, and whether hypertrophy or excess heart muscle has developed. A chest X-ray may help evaluate heart size and shape and may find excess fluid in the lungs due to abnormal heart function.
If further testing is required, often an echocardiogram (ultrasound) examination of the heart is helpful in visualizing the structures and functions of the heart. The echocardiogram can help to determine the specific diagnosis when a heart murmur is present. A cardiac catheterization is an invasive test whereby dye is injected directly into the blood passing through the heart structures to help evaluate their status.
What is the treatment for a heart murmur?
The treatment for heart murmur depends upon the particular cause and the underlying medical status of the patient. Many murmurs need no further evaluation, can be monitored, or are a normal variant. Some murmurs are associated with serious infected valves and require antibiotics. Some valves are structurally damaged and require surgical repair.
What are the complications of a heart murmur?
A heart murmur is the physical finding of an underlying structural issue within the heart. A heart murmur itself has no complications. The ramifications of a heart murmur are based on the particular underlying abnormality causing the murmur, and the effect it has on cardiac physiology.
Can heart murmur be prevented?
It is important to remember that a heart murmur is a physical finding and is not a disease or structural heart problem. Rather it is the sound that is made because of a potential blood flow problem within the heart. Maintaining a life-long heart-healthy lifestyle may help prevent some heart valve issues. These lifestyle opportunities include keeping blood pressure, cholesterol, and diabetes under control. It is a positive choice not to smoke. Regular exercise and weight management also contribute to a healthy heart.
Historically, rheumatic fever was a complication of strep throat (streptococcal pharyngitis). This could cause heart valve damage and the development of a heart murmur. With the advent of good screening tests for strep infections and the appropriate use of antibiotics, rheumatic fever is a rarely diagnosed condition.
What causes a heart murmur?
Functional heart murmurMany heart murmurs are harmless and referred to as innocent or functional. They are caused when blood rushes through the heart quickly during normal function while no heart disease may exist. There may be an underlying medical condition that can lead to an innocent murmur. These may include situations where the heart beats more quickly such as fever, anemia, hyperthyroidism, and pregnancy.
Congenital heart murmursCongenital heart murmurs are heard in the newborn. They may be due to abnormalities in the valves, septae, or arteries, and veins that carry blood to and from the heart. In some complicated heart disease conditions there may be a combination of all three. Many congenital heart murmurs resolve spontaneously without medical intervention while others require surgical operations for repair.
Patent ductus arteriosus (PDA) may cause a heart murmur in a newborn. Prior to birth, the aorta and pulmonary artery are connected by a small artery, the ductus arteriosus, to complete fetal blood circulation. Shortly after birth, this artery is supposed to close. If other congenital heart abnormalities exist, the ductus may remain open to help maintain some blood circulation. Sometimes, when no congenital abnormalities exist, the ductus doesn't completely close and a murmur may exist. Many times the patent ductus arteriosus closes by itself over time. Occasionally, medications or surgery may be required to close off the patent ductus arteriosus.
Valve abnormalitiesAbnormalities of the valves of the heart may cause a heart murmur. Any of the heart valves may be affected and clinical symptoms depend upon the severity of the valve damage and whether the blood flow pattern within the heart is maintained. Each valve problem often leads to a specific character and timing of heart murmur.
Holes in the walls of the heart (the septum that divides the heart chambers) can be the source of a heart murmur. Atrial septal defect (ASD) describes a hole in the wall that separates the collecting chamber of the heart while a ventricular septal defect (VSD) affects the wall dividing the pumping chamber.
What are the risk factors for heart murmur?
A heart murmur is a physical finding of an underlying heart condition and in many instances may be of no consequence. The risk factor for developing a particular murmur is the risk factor for the underlying condition.
Congenital heart disease tends to have a familial basis, meaning that there may be a genetic predisposition for a baby to develop a structurally abnormal heart.
Some valvular diseases are present at birth, but take a lifetime to develop symptoms. For example, the aortic valve is supposed to have three leaflets that come together; some people are born with a valve that has only two leaflets (bicuspid). Over time, a two-leafed valve may be more prone to calcification and narrowing. Symptoms may only be seen later in life.
Some valve diseases are due to infection and past rheumatic fever with heart valve inflammation due to a bacterial streptococcus infection. With present day screening for strep infections and the appropriate use of antibiotics, this risk factor has decreased significantly.
Other risk factors for heart valve abnormalities include atherosclerotic heart disease, heart attack, aortic aneurysm, and connective tissue disorders such as systemic lupus erythematosus and Marfan syndrome. Each condition affects the valves in a different way causing them to malfunction and develop the physical finding of a heart murmur.
What are the symptoms of a heart murmur?
A heart murmur in itself causes no symptoms and it generally cannot be heard by the person affected. It is the underlying structural issue of the heart that may cause problems. Note that many heart murmurs are of no consequence.
Congenital heart disease may present with newborns who have difficulty breathing and who are cyanotic, meaning that the heart cannot circulate blood and oxygen from the lungs to the body. Some infants with heart issues may have difficulty feeding, developing, and growing appropriately.
Most heart murmurs in well-developed children are harmless.
In adults, heart abnormalities may cause chest pain, shortness of breath, and swelling of the extremities among many other symptoms.
Palpitations or a sensation of an irregular heartbeat are occasionally seen in patients with heart valve abnormalities.
When should I seek medical care for a heart murmur?
A heart murmur generally does not cause any symptoms. It is the underlying heart function issues that often cause patients to seek medical help.
Chest pain and shortness of breath should always be taken seriously and not ignored. Medical help should be accessed immediately if a person has heart or lung concerns.
How is a heart murmur diagnosed?
A heart murmur is usually diagnosed during a physical examination by the health care practitioner while he or she listens to heart sounds with a stethoscope.
Patient historyEvaluation of the heart begins with questions relating to heart function. In an adult, some questions may include asking about chest pain or pressure, shortness of breath with exertion or at rest, and swelling of the legs. In an infant, the symptoms may include poor sucking or eating, poor weight gain and growth, or episodes of turning blue.
Physical examinationPhysical examination includes assessing skin color, feeling and assessing pulses, evaluating the legs looking for swelling and edema, and listening to the lungs for signs of fluid buildup.
Heart evaluation includes assessing the rate and rhythm of the heart. Is it too fast, too slow, regular, or irregular? The front of the chest can be palpated; a hand is placed on the area overlying the heart trying to feel for a vibration that can occur with an especially significant heart murmur.
Listening to the heart with the stethoscope begins with assessing basic first and second heart sounds, S1 and S2, which sound like "lub-dup." Potential extra heart sounds are referred to as S3 and S4. Should a heart murmur be heard, the health care practitioner will try to determine whether the sound is coming from an abnormal valve or a defect in the atrial or ventricular septum. The murmur is described whether it is heard in systole (when the heart is pumping) or diastole (when the heart is filling). The location on the chest and where the sound radiates is important in determining where the murmur originates. The intensity of the murmur is usually graded on a 6 point scale as follows:
Murmurs graded 4, 5, and 6 have an associated vibration (thrill) felt when the chest wall is palpated:
Many murmurs are diagnosed as normal (physiologic) based upon physical examination and require no further evaluation.
Initial testing may include an electrocardiogram (EKG) which can help evaluate the heart rate and rhythm, electrical conduction within the heart, and whether hypertrophy or excess heart muscle has developed. A chest X-ray may help evaluate heart size and shape and may find excess fluid in the lungs due to abnormal heart function.
If further testing is required, often an echocardiogram (ultrasound) examination of the heart is helpful in visualizing the structures and functions of the heart. The echocardiogram can help to determine the specific diagnosis when a heart murmur is present. A cardiac catheterization is an invasive test whereby dye is injected directly into the blood passing through the heart structures to help evaluate their status.
What is the treatment for a heart murmur?
The treatment for heart murmur depends upon the particular cause and the underlying medical status of the patient. Many murmurs need no further evaluation, can be monitored, or are a normal variant. Some murmurs are associated with serious infected valves and require antibiotics. Some valves are structurally damaged and require surgical repair.
What are the complications of a heart murmur?
A heart murmur is the physical finding of an underlying structural issue within the heart. A heart murmur itself has no complications. The ramifications of a heart murmur are based on the particular underlying abnormality causing the murmur, and the effect it has on cardiac physiology.
Can heart murmur be prevented?
It is important to remember that a heart murmur is a physical finding and is not a disease or structural heart problem. Rather it is the sound that is made because of a potential blood flow problem within the heart. Maintaining a life-long heart-healthy lifestyle may help prevent some heart valve issues. These lifestyle opportunities include keeping blood pressure, cholesterol, and diabetes under control. It is a positive choice not to smoke. Regular exercise and weight management also contribute to a healthy heart.
Historically, rheumatic fever was a complication of strep throat (streptococcal pharyngitis). This could cause heart valve damage and the development of a heart murmur. With the advent of good screening tests for strep infections and the appropriate use of antibiotics, rheumatic fever is a rarely diagnosed condition.
Source: http://www.rxlist.com
Source: http://www.rxlist.com
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