Heart murmur: Symptoms, Causes, and Treatments

What is a heart murmur?

First of all, it is necessary to clarify that a murmur is not a disease, but a condition. In this sense, a murmur consists of a noise caused by the movement of blood between the structures and vessels of the heart. This sound can be easily detected by a healthcare professional when a stethoscope is used to check heartbeats — a procedure called auscultation.

A murmur is divided into two categories: functional or innocent, and pathological. The first case is more common among children and adolescents, which is due to the characteristics of cardiovascular functioning in individuals in this age group.

This is because they have a thinner chest wall than an adult, a higher heart rate, and different angulation between the arteries. These factors cause the murmur which, in most patients, has no symptoms and ends up disappearing as the person develops physically.

When it comes to pathological murmurs, the condition arises due to changes in the cardiac structure. It is diagnosed more frequently in the adult population with a history of diseases that cause valve damage, such as rheumatic fever.

Symptoms

Some of the symptoms manifested are:

shortness of breath;
fatigue;
dizziness;
tachycardia;
fainting;
bluish discoloration of the skin on the fingertips, tongue, and lips;
sudden and unexplained weight gain;
fluid retention in the lower limbs;
enlargement of the neck veins.

Causes

An innocent murmur may occur in children and adolescents due to the patient’s physical structure. However, it may also be the result of intense physical exercise, hyperdynamic circulatory flow, or fever.

As for pathological murmurs, the development of the condition may occur due to degeneration of the heart valve, if the passage opening is reduced in size or closes with difficulty, causing blood to flow back through a small opening and produce the noise. The problem may also be congenital, that is, when the person is born with a murmur.

Diagnosis

The diagnosis of a heart murmur worries anyone, since we are talking about a problem that affects one of the most important organs of the human body. Characterized by an alteration in blood flow, the murmur produces a noise when the heart sound is auscultated, but its symptoms may vary according to the patient’s age group.

After confirmation, one of the main questions asked of the healthcare professional is whether the problem is curable. To have this answer, it is necessary to understand the causes of this alteration.

Receiving the correct evaluation is essential for successful treatment. With regard to innocent murmurs, in which there are no symptoms, the condition is usually identified during routine cardiac auscultation.

Once the professional notices noises in the heartbeats, the person is referred for specific tests. Among them is the echocardiogram — which is an ultrasound of the heart that captures images of its functional conditions and points out any abnormalities.

In the pathological condition, it is important for the person to pay attention to the symptoms their body manifests. However, it is important to emphasize that the signs of a murmur are similar to other heart diseases, such as heart failure. Therefore, only a consultation with a cardiologist and the performance of tests can confirm the diagnosis of a murmur.

Treatment

As it is a normal condition, an innocent murmur does not require treatment, since it disappears naturally. However, it is recommended to have follow-up with a cardiologist every six or 12 months to check whether there has been any change in the condition.

Treatment of pathological murmurs depends on each case. In general, the condition is treated with the introduction of medications that promote blood pressure control, facilitating the pumping of blood by the heart. In addition, medications that help control heart rate and reduce fluid accumulation in the lungs.

If the murmur is triggered by a disease that compromises the heart muscles or valves and, consequently, the full functioning of the organ, and the patient presents symptoms such as shortness of breath, surgery is required.

According to the particularities of the case, the procedure may be performed by balloon valve repair, in which a catheter is introduced into the patient and inflates a balloon to widen the valve. There is also correction by surgery, with opening of the chest to correct the problem, or valve replacement surgery, replacing natural valves with synthetic valves.

How is cardiac murmur managed in children?

Children with innocent murmurs do not present changes in the heart, which means they can lead a normal life and are even cleared to practice physical activities without restrictions. In cases in which the child is born with the problem, the physician generally opts for surgical treatment.

In more severe cases, surgery may also be performed in newborns. Due to advances in Fetal Medicine, such as the assistance of machines that allow extracorporeal circulation and the structure of ICUs, it is possible to perform pediatric surgical treatment increasingly earlier, which previously could only be done in those weighing more than 10 kilograms.

A heart murmur can only be discovered through a medical consultation and cardiological examination. Therefore, it is essential to notice the symptoms your body gives and to consult your doctor regularly, because the earlier the problem is discovered, the more easily it can be treated, in the case of pathological murmurs. It should be remembered that, even in cases of innocent murmurs, periodic return to medical consultations is necessary.

Technical review: Artur Codeço, medical coordinator at Hospital Israelita Albert Einstein