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Every beat of the heart makes a sound discernible by medical equipment; this is the heart valves opening and closing. If a doctor with a stethoscope, or any other device, notes an interruption or irregularity when listening to a patient's heart, they will note this murmur. There are two types of heart murmurs: innocent and abnormal. They can be present from birth or develop over time.

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Innocent Heart Murmurs

Newborns or children may have an innocent heart murmur and a normal heart. This occurs when blood flows quicker than normal through the heart. Some people experience this type of heart murmur during exercise, pregnancy, or rapid growth spurts. Fever, anemia, or hyperthyroidism can also cause an innocent murmur. If it does not disappear on its own over time, then an innocent murmur can be a life-long condition, but is unlikely to result from or cause any health problems.

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Abnormal Heart Murmurs in Children

An abnormal heart murmur is more serious than an innocent one. Children with congenital heart disease may develop this type of murmur, most commonly if they are born with a septal defect or hole in the heart or a cardiac shunt, which causes abnormal blood flow between the heart chambers or blood vessels. If the murmur resolves upon standing, this can rule out abnormal murmurs in children.

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Abnormal Heart Murmurs in Adults

Adults can develop abnormal heart murmurs due to acquired heart valve problems. In some cases, the abnormality is also congenital or present at birth but is not discovered until much later. Two common types are stenosis, which involves valves permitting too little blood, and regurgitation when valves leak and do not close properly.

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Other Causes of Abnormal Heart Murmurs

Older children or adults can develop abnormal heart murmurs from infections. For example, endocarditis occurs when bacteria spread throughout the bloodstream and lodge in the inner lining of the heart; this can eventually destroy heart valves. Valve calcification is the hardening of valves. These doorways can also become narrowed, restricting blood flow. Rheumatic fever, which can result from untreated strep throat, can lead to permanent damage to the heart valves.

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Symptoms

Both abnormal and innocent heart murmurs may or may not cause signs and symptoms. People who do develop symptoms may experience shortness of breath, chronic coughing, chest pain, dizziness, and heavy sweating with minimal exertion; a combination of these could indicate a heart disorder.

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More Symptoms of Heart Murmurs

Other signs and symptoms of a heart problem include an enlarged liver or veins in the neck, swelling, and sudden weight gain. In some cases, the individual's skin develops a bluish tinge, especially on the lips and fingertips, which indicates that blood is not circulating properly. Another sign, more common in children than adults, is poor appetite or failure to grow at an average pace.

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When to See a Doctor

Anyone who notices multiple symptoms listed above, or has any other reason to be concerned about the health of their heart, should speak to a doctor. Often, a doctor can use a stethoscope to identify a murmur and begin to determine the cause and severity. He or she may order further testing to develop a treatment plan. Though not necessary for innocent murmurs, echocardiography is warranted for suspected valve disease and in those with cardiac symptoms.

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Treatments

Innocent heart murmurs do not require medical treatment. Even some abnormal conditions require only monitoring over time and no prescriptions or surgery. In cases where specific treatment is necessary, the course of action will depend on the underlying heart problem that is causing the murmur. Medical or even surgical management may be required.

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Medication for Abnormal Heart Murmurs

A doctor may prescribe any number of medications for a heart murmur, depending on the cause. Anticoagulants prevent blood clots from forming in the heart. Water pills or diuretics can remove excess fluid, while statins help lower cholesterol. Beta-blockers lower blood pressure and heart rate and can treat heart valve problems. Angiotensin-converting enzyme (ACE) inhibitors also lower blood pressure.

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Surgery for Heart Murmurs

People with leaky or damaged heart valves will require more significant treatment than medication alone. Four procedures can repair a damaged valve: balloon valvuloplasty, annuloplasty, valve leaflet repair, and structural support repair. When the valve must be entirely replaced, surgical options include open-heart surgery and transcatheter aortic valve replacement (TAVR). The surgical team will determine the best option for each patient's condition.  

[References:

  1. Annals of Family Medicine. https://www.ncbi.nlm.nih.gov/pubmed/29133490
  2. British Heart Journal. https://www.ncbi.nlm.nih.gov/pubmed/7356863
  3. American Journal of Emergency Medicine. https://www.ncbi.nlm.nih.gov/pubmed/30001813
  4. Journal of the American College of Cardiology. https://www.ncbi.nlm.nih.gov/pubmed?term=24603191
  5. Journal of the American Heart Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937264/

Disclaimer

This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.