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Definition
A heart murmur is an abnormal sound made by turbulent blood flow in the heart. Some adults and many children have incidental heart murmurs that are harmless (benign). At least 30% of children may have an innocent heart murmur at some point during childhood. However, some heart murmurs can signal an underlying heart problem.
Heartbeat: Anatomy of the Heart
2008 Nucleus Medical Art, Inc.
Causes
Benign heart murmurs are caused by:
- Turbulent blood flow through a highly dynamic, but normal circulatory system
- Slight valvular abnormality with no long-term consequences (such as mitral valve prolapse , a congenital condition)
Abnormal heart murmurs can be due to:
- Structural abnormalities of the heart valve (most common):
- Congenital (present at birth) defects
- Acquired (eg, arteriosclerosis , rheumatic fever )
- Structural abnormality of the heart muscle:
- Congenital defects
- Acquired (eg, myocardial infarction , congestive heart failure , long-standing high blood pressure )
- Abnormal holes in the structure of the heart persisting after birth:
- Septal defects connection between the heart's chambers
- Patent ductus-arteriosus connection between the major artery and vein of the heart
- Endocarditis infection of the inner lining of heart valves and chambers (endocardium)
- Pericarditis inflammation of the saclike membrane that encloses the heart (pericardium). This may be caused by:
- Severe kidney disease
- Heart attack
- Autoimmune disease
- Cardiac myxomaa benign soft tumor within the heart (rare)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for normal heart murmurs include: Age: 3-7 years oldPregnancy Risk factors for abnormal heart murmurs include: Rheumatic feverArteriosclerosisHigh blood pressureAutoimmune diseaseCongenital heart defects or disease SymptomsBenign heart murmurs usually cause no symptoms. Patients with mitral valve prolapse sometimes complain of vague chest discomfort and other symptoms. It remains unclear whether or not the valvular abnormality is causing the symptoms. Symptoms of abnormal heart murmurs include: Shortness of breathLightheadednessChest painPalpitations (feeling of rapid or irregular heartbeat)Exercise intolerance DiagnosisMost benign heart murmurs are diagnosed during the course of a routine physical exam with a stethoscope. Some abnormal heart murmurs are also discovered this way. Other abnormal heart murmurs are discovered initially by their symptoms. Tests may include: Electrocardiogram a test that records the heart's electrical activity using electrodes attached to the surface of the chest. This does not diagnose the cause of the murmur, but can provide other useful information about the condition of the heart. Chest x-rayan x-ray to determine the approximate size and shape of the heart, and the presence of associated lung swelling (pulmonary edema)Echocardiogram a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart Cardiac catheterization a tube inserted into the heart through an artery (usually in the groin) to detect problems with the heart's structure, function, and blood supply Blood teststo check for evidence of a recurrent heart attack or other diseases that may affect the heart (eg, kidney disease, infections, autoimmune conditions) TreatmentBenign heart murmurs require no treatment. Treatment of other heart murmurs depends on the underlying cause and extent of the problem.
Treatments include: Medication Medications can either treat the cause of the heart abnormality associated with the murmur or help compensate for its dysfunction: Diuretics, angiotensin-converting enzyme inhibitors, digitalisto treat heart failureAntibioticsto prevent or treat endocarditisAnti-inflammatory drugsto treat pericarditis Surgery Surgery is often necessary to treat severe heart abnormalities: Replacement of defective heart valves with artificial onesCorrection of congenital heart defectsRemoval of heart tumors Prevention Preventing benign heart murmurs are unnecessary. To help reduce your risk of developing an abnormal heart murmur: Get prompt testing and treatment for strep throat to prevent rheumatic fever. Reduce your risk of atherosclerosis to help prevent valvular heart disease in the distant future. To do this: Eat a low fat diet.Get regular exercise.Monitor blood pressure.If you have valvular heart disease, even if you have no symptoms, you may be at risk for endocarditis. It may be necessary to take antibiotics before and after any medical or dental procedure that could allow bacteria to enter your blood stream. Also, never use intravenous drugs.
RESOURCES: American Heart Associationhttp://www.americanheart.org Heart Information Networkhttp://www.heartinfo.org CANADIAN RESOURCES: Canadian Cardiovascular Societyhttp://www.ccs.ca/home/index_e.aspx Canadian Family Physicianhttp://www.cfpc.ca/cfp/ References: American Heart Association website. Available at: http://www.americanheart.org . Accessed October 13, 2005. Harvard Medical School Consumer Health Information website. Available at: http://hms.harvard.edu/hms/info.asp . Accessed October 13, 2005. The Merck Manual of Medical InformationHome Edition . Simon and Schuster, Inc; 2000. Last reviewed December 2007 by J. Peter Oettgen, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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