Definition, Description, Causes and symptoms, Diagnosis, Treatment, Alternative treatment, Prognosis
A heart murmur is an abnormal, extra sound during the heartbeat cycle made by blood moving through the heart and its valves. It is detected by the physician's examination using a stethoscope.
A heart which is beating normal makes two sounds, "lubb" when the valves between the atria and ventricles close, and "dupp" when the valves between the ventricles and the major arteries close. A heart murmur is a series of vibratory sounds made by turbulent blood flow. The sounds are longer than normal heart sounds and can be heard between the normal sounds of the heart.
Heart murmurs are common in children and can also result from heart or valve defects. Nearly two thirds of heart murmurs in children are produced by a normal heart and are harmless. This type of heart murmur is usually called an "innocent" heart murmur. It can also be called "functional" or "physiologic." Innocent heart murmurs are usually very faint, intermittent, and occur in a small area of the chest. Pathologic heart murmurs may indicate the presence of a serious heart defect. They are louder, continual, and may be accompanied by a click or gallop.
Some heart murmurs are continually present; others happen only when the heart is working harder than usual, including during exercise or certain types of illness. Heart murmurs can be diastolic or systolic. Those which occur during relaxation of the heart between beats are called diastolic murmurs. Those which occur during contraction of the heart muscle are called systolic murmurs. The characteristics of the murmur may suggest specific alterations in the heart or its valves.
Causes and symptoms
Innocent heart murmurs are caused by blood flowing through the chambers and valves of the heart or the blood vessels near the heart. Sometimes anxiety, stress, fever, anemia, overactive thyroid, and pregnancy will cause innocent murmurs that can be heard by a physician using a stethoscope. Pathologic heart murmurs, however, are caused by structural abnormalities of the heart. These include defective heart valves or holes in the walls of the heart. Valve problems are more common. Valves that do not open completely cause blood to flow through a smaller opening than normal, while those that do not close properly may cause blood to go back through the valve. A hole in the wall between the left and right sides of the heart, called a septal defect, can cause heart murmurs. Some septal defects close on their own; others require surgery to prevent progressive damage to the heart.
The symptoms of heart murmurs differ depending on the cause of the heart murmur. Innocent heart murmurs and those which do not impair the function of the heart have no symptoms. Murmurs that are due to severe abnormalities of a heart valve may cause shortness of breath, dizziness, chest pains, palpitations, and lung congestion.
Heart murmurs can be heard when a physician listens to the heart through a stethoscope during a regular checkup. Very loud heart murmurs and those with clicks or extra heart sounds should be evaluated further. Infants with heart murmurs who do not thrive, eat, or breath properly and older children who lose consciousness suddenly or are intolerant to exercise should also be evaluated. If the murmur sounds suspicious, the physician may order a chest x ray, an electrocardiogram, and an echocardiogram.
An electrocardiogram (ECG) shows the heart's activity and may reveal muscle thickening, damage, or a lack of oxygen. Electrodes covered with conducting jelly are placed on the patient's chest, arms, and legs. They send impulses of the heart's activity through a monitor (oscilloscope) to a recorder which traces them on paper. The test takes about 10 minutes and is commonly performed in a physician's office. An exercise ECG can reveal additional information.
An echocardiogram (cardiac ultrasound), may be ordered to identify a structural problem that is causing the heart murmur. An echocardiogram uses sound waves to create an image of the heart's chambers and valves. The technician applies gel to a hand-held transducer then presses it against the patient's chest. The sound waves are converted into an image that can be displayed on a monitor. Performed in a cardiology outpatient diagnostic laboratory, the test takes 30 minutes to an hour.
Innocent heart murmurs do not affect the patient's health and require no treatment. Heart murmurs due to septal defects may require surgery. Those due to valvular defects may require antibiotics to prevent infection during certain surgical or dental procedures. Severely damaged or diseased valves can be repaired or replaced through surgery.
If a heart murmur requires surgical treatment, there are no alternative treatments, although there are alternative therapies that are helpful for pre- and post-surgical support of the patient. If the heart murmur is innocent, heart activity can be supported using the herb hawthorn (Crataegus laevigata or C. oxyacantha) or coenzyme Q10. These remedies improve heart contractility and the heart's ability to use oxygen. If the murmur is valvular in origin, herbs that act like antibiotics as well as options that build resistance to infection in the valve areas may be considered.
Most children with innocent heart murmurs grow out of them by the time they reach adulthood. Severe causes of heart murmurs may progress to severe symptoms and death.
Gutgesell, Howard P., et al. "Common Cardiovascular Problems in the Young: Part I. Murmurs, Chest Pain, Syncope and Irregular Rhythms." American Family Physician 56, no. 7 (1 Nov. 1997): 1825-1827.
Sapin, Samuel. "Recognizing Normal Heart Murmurs: A Logic-Based Mnemonic." Pediatrics 99, no. 4 (1 Apr.1997): 616.
Smith, Karen M. "The Innocent Heart Murmur in Children." Journal of Pediatric Health Care 11, no. 5 (Sept./Oct.1997): 207-214.
American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. <http://www.americanheart.org>.
Texas Heart Institute. Heart Information Service. PO Box 20345, Houston, TX 77225-0345. <http://www.tmc.edu/thi>.
"Heart Murmurs in Infants: Not Always Cause for Alarm." Mayo Clinic Online. 26 Feb. 1998. 5 Mar. 1998 <http://www.mayohealth.org>.
"When Your Child's Doctor Hears a Heart Murmur." Children's National Medical Center. 1998. 6 Mar. 1998 <http://www.cnmc.org/heart.htm>.
Lori De Milto
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