Heart Murmur

Overview

A heart murmur is an extra sound your doctor hears through a stethoscope when listening to your heart. Instead of just the usual 'lub-dub', there is also a soft 'whoosh' or 'swish'. It happens when blood flows faster than usual or moves through a slightly rough patch, often in one of the heart valves. A murmur is a sound, not a disease — it is a clue. Many murmurs are completely harmless, especially in children. Some can be a sign of a valve or heart problem that should be checked.

Yes, very common. Innocent (harmless) murmurs are especially common in children — many children have one at some point and outgrow it. Pregnancy, fever and anaemia can also cause a temporary murmur because blood flows faster.

Anyone at any age. They are most often noticed in children, in pregnant women (because there is more blood flowing), and in older adults, whose heart valves can thicken or stiffen with age.

Symptoms

Common symptoms

• Often no symptoms at all — the murmur is found during a routine examination
• A soft whooshing or swishing sound heard through a stethoscope
• Feeling more tired than usual, especially with activity
• Shortness of breath when active
• Dizziness or light-headedness
• Chest discomfort
• A feeling that your heart is racing, pounding or fluttering (palpitations)
• Swelling in the ankles or feet, if a valve problem is the cause

Symptoms in children

• Most children with a murmur have no symptoms and grow and play normally
• Babies may feed slowly or gain weight more slowly than expected
• Getting tired quickly during play
• Sweating while feeding
• Frequent chest infections
• A blue or grey tint to the lips or skin — this needs urgent medical care
• The murmur often gets quieter or disappears as the child grows

Symptoms in older adults

• Shortness of breath, especially when lying flat or at night
• Swelling in the legs and ankles
• Tiredness and being less able to exercise than before
• Dizziness or fainting
• Palpitations
• The murmur may be linked to valves becoming thicker or stiffer with age

Causes

Main causes

• Innocent (normal) flow murmur — blood flowing normally through a healthy heart; common in children, pregnancy, fever, anaemia and during exercise
• Heart valve problems — a valve that is too narrow (stenosis) or does not close tightly (regurgitation)
• Thickening or hardening of valves with age, which is common in older adults
• Congenital heart problems — heart conditions present from birth
• Infection of a heart valve (endocarditis) — rare but serious
• Other heart conditions such as a weakened heart muscle or high blood pressure
• Anaemia, thyroid problems or fever, which make blood flow faster

Risk factors

• Being a child or teenager (harmless murmurs are very common)
• Pregnancy
• Older age, as valves can stiffen
• Family history of heart valve problems or congenital heart disease
• Rheumatic fever in the past
• High blood pressure, high cholesterol, smoking or diabetes
• A previous heart infection or a heart condition present from birth
• Anaemia or an overactive thyroid

When to see a doctor

See a doctor urgently if:

• Chest pain or pressure
• Fainting or nearly fainting
• New or severe breathlessness, or breathlessness at rest
• Blue or grey lips or fingertips
• Fever with a known murmur
• New swelling in the legs or ankles

Book a routine appointment if:

• Your doctor has heard a murmur and wants it checked
• You feel more tired or more breathless than usual with activity
• You notice palpitations, dizziness or chest discomfort
• You have a family history of heart valve problems or congenital heart disease
• You have questions or feel anxious about a murmur that was found

Diagnosis

Most murmurs are found when a doctor listens to your heart with a stethoscope. They will ask about your symptoms and health history, check your pulse and blood pressure, and listen carefully to when and where the sound happens. From that, they decide whether any further tests are needed. Many harmless murmurs need no tests at all — just a follow-up listen.

Tests that may be done

• A physical examination, including listening to your heart and lungs
• Echocardiogram — a painless ultrasound scan of the heart that shows how the valves and blood flow look
• ECG (electrocardiogram) — a quick, painless tracing of the heart's electrical rhythm
• Chest X-ray
• Blood tests to check for anaemia, infection or thyroid problems
• A wearable heart monitor for a day or more, if you have palpitations or dizzy spells
• An exercise or stress test, where your heart is monitored while you move

What to expect at your appointment

It is usually quick and gentle. You will likely have an examination and sometimes an ultrasound scan of the heart, which involves lying still while a probe is moved over your chest. There are no needles and no pain. Results often come the same day or within a week or two. If everything is normal, you may not need any further follow-up.

Treatment

Treatment depends entirely on the cause. Harmless murmurs need no treatment at all — just routine check-ups and peace of mind. If a valve or other heart problem is found, your team may suggest regular monitoring, heart-healthy lifestyle changes, medicines, or a procedure to repair or replace a valve. The murmur itself is not treated; the underlying cause is.

Self-care at home

• Keep any follow-up appointments your doctor recommends
• Write down new symptoms — breathlessness, dizziness, swelling — and mention them at your next visit
• Stay active in ways that feel comfortable for you
• Do not smoke, and avoid secondhand smoke
• Keep your blood pressure, cholesterol and blood sugar in a healthy range
• Stay at a healthy weight and limit alcohol
• Keep up to date with recommended vaccinations
• Tell your dentist and any other doctor about your murmur before procedures — some people are advised to take antibiotics before dental work, but only if their own doctor advises it

Medical treatments

Your healthcare team may recommend regular check-ups and heart ultrasound scans to keep an eye on a valve over time. When needed, medicines can help the heart pump better, lower blood pressure, steady the heart rhythm, or reduce swelling and fluid build-up. Antibiotics are used if there is an infection. Any medicine would be chosen and adjusted by your own clinical team to suit your situation — always follow their advice and ask your pharmacist if you are unsure about anything.

When is surgery considered?

If a valve is badly narrowed or leaking and it is causing symptoms or strain on the heart, a heart specialist may discuss a procedure. This could be surgery to repair or replace the valve, or in some cases a less invasive procedure done through a tube in a blood vessel. It is only considered when the benefits clearly outweigh the risks, and the decision is made together with your heart team.

Living with this condition

For most people, a murmur changes nothing about daily life. If you have a valve condition, you may have regular check-ups and learn to pace yourself a little. Many people with murmurs — even those needing treatment — go on to live full and active lives.

Lifestyle tips

• Stay physically active with activities that suit your body and your heart
• Eat a balanced diet with plenty of vegetables, fruit, whole grains and lean protein
• Keep salt moderate, especially if you have swelling or high blood pressure
• Do not smoke, and avoid secondhand smoke
• Limit alcohol
• Get enough sleep and find ways to manage stress
• Keep up with vaccinations
• Tell your doctor promptly if your symptoms change

Diet and exercise

Gentle to moderate exercise is good for your heart. If you have a heart valve condition, ask your team what level of activity is right for you — most people can exercise normally. A heart-healthy diet with less salt and less processed food helps keep blood pressure and swelling in check.

Mental health and emotional wellbeing

Hearing the word 'murmur' can be worrying, especially for parents. Feeling anxious is completely normal. Remember that most murmurs turn out to be harmless. If worry is affecting your sleep, mood or daily life, tell your doctor — talking it through with someone can help a great deal, and emotional support is part of your care.

Prevention

Most murmurs cannot be prevented, because they come from how your heart formed or from normal blood flow. But you can lower the risk of heart problems that can cause murmurs by looking after your heart: keeping blood pressure and cholesterol healthy, not smoking, staying active, and getting a sore throat or suspected strep infection checked promptly (to help prevent rheumatic fever).

Vaccines

Keep up to date with the vaccinations recommended for you. Your doctor may especially suggest flu and pneumonia-related vaccines if you have a heart condition. Ask your GP or pharmacist what is recommended in your case.

Screening programmes

There is no routine screening programme for heart murmurs. They are usually picked up during a normal check-up when a doctor listens to your heart. If you have a family history of heart valve problems or congenital heart disease, tell your doctor — they may suggest a check.

Complications

If left untreated

• If the murmur is harmless — which is most often the case — there are no complications at all
• If a valve problem is present and not checked, it can slowly worsen and put strain on the heart
• Heart rhythm problems, such as an irregular or fast heartbeat
• Heart failure — the heart becoming less able to pump blood around the body
• Infection of a heart valve, which is rare but serious
• Blood clots, which can in some cases lead to a stroke

Long-term outlook

The outlook is generally very good. Most murmurs are harmless and never cause any problems. When a valve issue is found, it is often caught early, and there are effective ways to monitor and treat it. Most people — with or without treatment — continue to live normal, active lives.

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