Doctor, I have a heart murmur… What does that mean?
A heart murmur is a sound heard when listening to the heart with a stethoscope. It results from the turbulence of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow through the heart’s valves, causing the surrounding walls to vibrate, which produces this characteristic sound.
Normally, Everything is Silent
The heart is made up of four chambers and four valves that ensure bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flows in only one direction, without any backflow.
Normally, the movement of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood through the heart does not produce any sound. What is heard is only the closing of the valves.
An example
Let’s take an example: A stream with no obstacles in its path flows quietly. If we introduce some small waterfalls, the resulting turbulence creates the charming sound of flowing water.
Sound with or without a Heart Anomaly
In the heart, the causes of turbulence can vary.
This sound may be heard normally under certain circumstances, but it can also result from a heart anomaly in other situations.
A Murmur without Heart Anomaly
A physiological murmur, meaning a murmur without a heart anomaly, is also known as a “functional murmur.” It is caused by turbulence from a higher-than-normal bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow through the heart. Some common examples include:
- The rapid growth spurt during adolescence
- Fever (especially in childhood)
- Pregnancy
- Anemia
- Hyperthyroidism
Presence of a Heart Anomaly
A murmur associated with a heart anomaly can be of three types:
- A stenosis of a heart valve
- An incompetent valve that “leaks”
- A hole in the interatrial or interventricular septum
Normal Heart Auscultation with Two Sounds
Normal heart auscultation consists of two sounds, corresponding to the closure of the heart valves. These sounds can be mimicked by “lub” and “dub.”
The first sound, “lub,” corresponds to the closure of the valves between the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles. and ventricles, namely the tricuspid and mitral valves.
The second sound, “dub,” corresponds to the closure of the aortic and pulmonary valves.
Between the “lub” and the “dub,” there is normally no sound, and similarly, it is silent between the “dub” and the next “lub.”
A Heart Murmur is an Additional Sound
A heart murmur presents as an extra sound between the two normal heartbeats. You might hear sounds like “lub-chiii-dub” or “lub—dub-chuuu.”
"Lub---dup-chuuu"
In the case of “lub—dup-chuuu,” this indicates a murmur that occurs during the heart’s resting phase.
This type of murmur almost always points to aortic valveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >> regurgitation, meaning the valve allows bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood to flow back from the aorta into the left ventricle.
This sound can also be heard in cases of pulmonary valve insufficiency or mitral valve stenosis, although these conditions are much less common.
« Lub-chiii-dup »
A murmur represented by “lub-chiii-dup” is a systolic murmur, heard during the contraction phase of the heart, known as systole. Functional murmurs fall into this category. Some of the cardiac anomalies responsible for this type of murmur include:
- Aortic sclerosis
- Aortic stenosis
- Mitral regurgitation
- Ventricular septal defect (VSD)
- Patent foramen ovale (PFO)
- Atrial septal defect (ASD)
In cases of PFO and ASD, the murmur is not directly caused by the passage of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood between the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles., but rather by increased bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow in the heart.
This higher flow results from the transfer of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood between the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles., adding to the normal volume of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood present.
A chance discovery
The vast majority of people with a heart murmur are unaware of it. This murmur is often discovered by chance during a routine visit to the doctor.
Determining its origin
Once the murmur is discovered, the doctor uses various tests to determine its cause.
The doctor can often have a good idea of the underlying issue by identifying where the sound is loudest on the chest and analyzing when this additional sound occurs during the heart examination.
Tests to be performed
The two most commonly requested tests are the electrocardiogram (ECG) and the resting transthoracic echocardiogram (TTE).
In some cases, a transesophageal echocardiogram (TEE) may be necessary, particularly to evaluate a patent foramen ovale (PFO), atrial septal defect (ASD), or ventricular septal defect (VSD).
The next steps depend on the underlying cause
The course of action will be determined by the underlying condition responsible for the heart murmur.
Communicating the information
It may happen that you meet healthcare professionals who are unfamiliar with your medical history. It is essential to inform every professional that you have a heart murmur.
Even more importantly, if you know the cause of the murmur, make sure to explain it to them.
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