What Does It Mean When a Heart Valve Murmur Is Heard?

When your doctor listens with a stethoscope during a routine examination and says “you have a murmur in your heart”, it understandably worries many people. In this article I will explain what a heart murmur means and when we need to take it seriously.

What Is a Heart Murmur? Innocent Murmur vs Pathological Murmur

A murmur is an additional sound, audible with a stethoscope, produced by blood flowing within the heart or passing through the valves. Some murmurs are completely harmless (innocent/functional murmurs); they can appear particularly in children, pregnant women or patients with a fever, in situations where blood flows faster than normal, and they point to no structural problem at all. Pathological murmurs, on the other hand, are the sound of a genuine valve stenosis, valve regurgitation or a structural abnormality.

Which Murmurs Are a Sign of Serious Disease?

The loudness of the murmur, its timing (which phase of the heartbeat it is heard in), how far it radiates and any accompanying symptoms (shortness of breath, chest pain, fainting) give us important clues as to whether it is innocent or pathological. As a general rule, murmurs that are new, loud, accompanied by symptoms, or heard during the diastolic (filling) phase of the heartbeat should be taken more seriously.

Definitive Diagnosis With Echocardiography (EKO)

The most reliable way to determine definitively whether a murmur is innocent or pathological is echocardiography (imaging the heart with ultrasound); this test clearly shows the structure of the valves, how well they open and close, and the overall function of the heart. When we hear a suspicious murmur, we recommend clarifying the situation with this test without worrying the patient unnecessarily.

Frequently Asked Questions

Does every murmur mean there is a disease? No; many murmurs heard in children and young people in particular are completely harmless and require no treatment.

Should echocardiography be performed as soon as a murmur is heard? If it has suspicious features (new onset, loud, accompanied by symptoms) then yes; if the suspicion of anything beyond an innocent murmur is low, clinical follow-up may be sufficient.

A murmur was heard in my child; should I be worried? The great majority of murmurs heard in childhood are innocent; even so, we recommend that you keep to the follow-up your doctor advises and have an echocardiogram if needed.

Conclusion

A heart murmur is not a disease in itself but a finding that calls for more detailed assessment. Although it is harmless most of the time, making the definitive distinction with echocardiography is the safest approach.

If a murmur was detected during your examination, you can book an appointment for a detailed echocardiographic assessment.

References

1. Etchells E, Bell C, Robb K. Does This Patient Have an Abnormal Systolic Murmur? JAMA. 1997;277(7):564-571.
2. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227.