If your heart murmurs, tell it to speak up so the doctor can understand what it is saying!

Because people know I write a blog about heart failure, they often ask me questions about various heart terms they may have heard.  Recently, a friend asked me what the term “heart murmur” means.  I had to admit that I did not know the answer, but suspected it might have to do with a heart valve.

Well, imagine my surprise when I started to research the issue and realized that I probably fall in the category of people with heart murmurs!  So I decided that it is a perfect topic for a blog post.
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Before I even began to look up the term, I assumed that a heart murmur was probably notable because it would mean the heart was making a specific sound.  That was a good guess, based on what I found on the Cleveland Clinic website: 

• "The doctor listens to your heart at different places on your chest to hear the sounds your heart valves make as blood travels through your heart. Normally, the heart beat has two sounds – lub-dub. The first sound is heard as the mitral and tricuspid valves close. The second heart sound is the aortic and pulmonic valves snapping shut.***A heart murmur is a swishing sound heard when there is turbulent or abnormal blood flow across the heart valve."

The first question that appeared in my mind is what causes this abnormal blood flow.  Well if you continue to read the information on the Cleveland Clinic website, you will find that there are four potential causes:  valvular stenosis, valvular regurgitation, hypertrophic cardiomyopathy and septal defect.  I have mitral valve regurgitation (also known as a leaky mitral valve), so that is what leads me to wonder if I have a heart murmur even though I have not seen it listed as an issue on any of my medical reports.  I need to ask my doctor at my next appointment!  Maybe they have just run out of room to list all my heart's little eccentricities!

Heart murmurs fall into two categories:  innocent and abnormal (although the lawyer in me thinks that a guilty category would make more sense than an abnormal one!).  According to the Mayo Clinic, an innocent heart murmur occurs when blood flows more rapidly than normal through the heart because of either:  physical activity or exercise, pregnancy, fever, anemia, hyperthyroidism or phases of rapid growth such as adolescence.

The Mayo Clinic also says that an abnormal heart murmur is:  either the result of a structural heart problem one is born with (congenital), or infections and conditions that damage the structures of the heart and are more common in older children or adults.  These conditions include things like:  valve calcification (hardening of the valves), endocarditis (infection of the valve’s inner linings), and rheumatic fever. 

The British Heart Foundation website has a two-page heart murmurs information sheet that you can download.  It says:  "Murmurs can be heard when the heart contracts (a systolic murmur) or when the heart relaxes (a diastolic murmur). People who have a healthy heart can sometimes have murmurs. People with anemia can have murmurs and they are often heard in pregnant women due to the unusually large flow of blood through the heart".  

The Cleveland Clinic website advises that if there is a heart murmur caused by a heart valve problem, a  follow-up visit with a cardiologist will be required to evaluate the progression of the valve disease.  The Cleveland Clinic also cautions that most people who have a heart murmur require measures to prevent valve infection. These include:

• Tell all your doctors and dentist you have valve disease

• Call your doctor if you have symptoms of an infection
• Take good care of your teeth and gums take antibiotics before you undergo any procedure that may cause bleeding
• A wallet card may be obtained from the American Heart Association with specific antibiotic guidelines. Call your local American Heart Association office or nationally, 800.AHA.USA1 or go to www.heart.org/HEARTORG.

With respect to the third measure, I always take the drug clindamycin before I have any dental procedure, to include routine cleanings.

The INOVA Hospital website, in conjunction with the Valley Health Network, has the following advice for treating heart murmurs.  "Innocent heart murmurs will likely not need treatment unless there is an underlying cause that needs treatment (for example, anemia).  Abnormal heart murmur treatment protocols include: medication to help relieve symptoms, procedures or surgery to fix or replace a diseased or damaged heart valve, or procedures or surgery to fix a hole in the heart."

How does one know whether it is an innocent or an abnormal heart murmur?  According to the Mayo Clinic website, your doctor will consider the following to make that determination:

• How loud is it? This is rated on a scale from 1 to 6, with 6 being the loudest.  
• Where in your heart is it? And can it be heard in your neck or back?
• What pitch is it? Is it high-, medium- or low-pitched?
• What affects the sound? If you change your body position or exercise, does it affect the sound?
• When does it occur, and for how long? Murmurs that happen when the heart is filling with blood (diastolic murmur) or throughout the heartbeat (continuous murmur) may indicate a heart problem. You or your child will need more tests to find out what the problem is. Murmurs that occur when the heart is emptying (systolic) generally are innocent heart murmurs that don't cause health issues, but sometimes they may reflect a heart condition.

So abnormal means unusual or atypical, but does that mean that it is dangerous to have an abnormal heart murmur?  Well according to the INOVA website, complications of heart murmurs can be quite serious if not deadly.   Possible complications include:

• Heart failure. This problem occurs when the heart is so weak it no longer pumps blood well.
• Infection of the heart’s valves or inner lining (infective endocarditis)
• Blood clots and stroke
• Fainting
• Heart attack
• Sudden cardiac arrest. This problem occurs when the heart suddenly stops beating.

​So the bottom line is if you think your heart is murmuring to you, it may be time to expand the conversation to include your doctor.  If it’s an innocent murmur, you can then converse with your heart sans anxiety and sans doctor.  But if it’s an abnormal murmur, then it really is time to have the heart step it up and give your doctor some clear feedback on what’s going on.