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Heart murmurs and other sounds
Definition
A heart murmur is a blowing, whooshing, or rasping sound heard during a heartbeat. The sound is caused by rough blood flow through the heart valves or near the heart.
Alternative Names
Chest sounds - murmurs; Heart sounds - abnormal; Murmur - innocent; Innocent murmur; Systolic heart murmur; Diastolic heart murmur
Considerations
The heart has four chambers:
- Two upper chambers (atria)
- Two lower chambers (ventricles)
The heart has valves that close with each heartbeat, causing blood to flow in only one direction. The valves are located between the chambers.
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Murmurs can happen for many reasons, such as:
- When a valve does not close tightly and blood leaks backward (regurgitation)
- When blood flows through a narrowed or stiff heart valve (called stenosis)
There are several ways in which your doctor may describe a murmur:
- Murmurs are classified ("graded") depending on how loud the murmur sounds with a stethoscope. The grading is on a scale. Grade I can barely be heard. An example of a murmur description is a "grade II/VI murmur." (This means the murmur is grade 2 on a scale of 1 - 6).
- In addition, a murmur is described by the stage of the heartbeat when the murmur is heard. A heart murmur may be described as systolic or diastolic.
When a murmur is more prominent, the doctor may be able to feel it with the palm of the hand over the heart.
The doctor will take the following into consideration when examining you:
- Does the murmur occur when the heart is resting or contracting?
- Does it last throughout the heartbeat?
- Does it change when you move?
- Can it be heard in other parts of the chest, on the back, or in the neck?
- Where is the murmur heard the loudest?
Causes
Many heart murmurs are harmless. These types of murmur are called innocent murmurs. They will not cause any symptoms or problems. Innocent murmurs do not need treatment.
Significant murmurs can be caused by:
- Aortic regurgitation
- Aortic stenosis
- Hypertrophic cardiomyopathy (idiopathic hypertrophic subaortic stenosis)
- Mitral regurgitation - acute
- Mitral regurgitation - chronic
- Mitral stenosis
- Pulmonary regurgitation (backflow of blood into the right ventricle, caused by failure of the pulmonary valve to close completely)
- Pulmonary stenosis
- Tricuspid regurgitation
- Tricuspid stenosis
Significant murmurs in children are more likely to be caused by:
- Anomalous pulmonary venous return (an abnormal formation of the pulmonary veins)
- Atrial septal defect (ASD)
- Coarctation of the aorta
- Patent ductus arteriosus (PDA)
- Ventricular septal defect (VSD)
Children often have murmurs as a normal part of development. These murmurs do not require treatment, and may include:
- Pulmonary flow murmurs
- Still's murmur
- Venous hum
What to Expect at Your Office Visit
A doctor or nurse can listen to your heart sounds using a tool called a stethoscope, which is placed over your chest. You will be asked questions about your medical history and symptoms, such as:
- Have other family members had murmurs or other abnormal heart sounds?
- Do you have a family history of heart problems?
- What other symptoms do you have, such as:
- Bluish skin color (cyanosis)
- Chest pain
- Distended neck veins
- Fainting (syncope)
- Liver enlargement
- Lung sound changes
- Shortness of breath
- Swelling
- Weight gain
The doctor may ask you to squat, stand, or hold your breath while bearing down or gripping something with your hands to listen to your heart.
The following tests may be done:
References
Goldman L. Approach to the patient with possible cardiovascular disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24thed. Philadelphia, PA: Saunders Elsevier; 2011:chap 50.
Sabatine MS, Cannon CP. The history and physical examination:an evidence-based approach. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald'sHeart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 12.
Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr., Faxon DP, Freed MD, et al. 2006 Writing Committee Members; American College of Cardiology/American Heart Association Task Force. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:e523-e661.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
