Heart murmurs - Causes, Symptoms, Risk, Diagnosis and Treatment

What Are Heart Murmurs?

Heart murmurs are sounds occurring during the cycle of a heartbeat. The normal heartbeat sound is lub and dub. The variation of sound occurs in cases of abnormality. These heart murmurs are heard with the help of a stethoscope. The murmurs are a relatively prolonged series of auditory vibrations. It may be of variable intensity, quality, and frequency. It is due to turbulence that arises when blood flow increases due to increased flow through a constricted or irregular opening of the heart valve.

What Are the Characteristics of Murmurs?

Heart murmurs should be described in the following ways:

• The murmur is heard clearly over the area of the precordium. Precordium is the area on the thorax immediately over the heart.

• The murmur should be identified as systolic or diastolic.

• The timing and character of the murmur vary in different conditions.

• The intensity of a murmur is studied under the grading system.

• The pitch of the murmur may be categorized as a low or high pitch.

• Conduction of the murmur.

• The variation of the murmur with respiration is a specific character regarding the heart murmurs. The left-sided murmurs are the best heard in expiration, whereas right-sided murmurs are the best heard in inspiration.

• Posture in which murmur is best heard is the left lateral position.

• The heart sounds might show variations when it is heard in the bell or diaphragm of the stethoscope.

What Are Different Heart Murmurs?

• Carey – Coombs Murmur: It is a short mid-diastolic murmur. It is heard at the apex of the heart. It can be heard in cases of mitral valvulitis of acute rheumatic fever.

• Austin Flint Murmur: It is a low pitched rumbling sound heard at the apex. It can be heard in patients with severe aortic regurgitation.

• Ryland’s Murmur: It is heard in cases of complete heart block.

• Gibson Murmur: It is a continuous machinery murmur heard in patients with patent ductus arteriosus.

• Graham Steel Murmur: It is a high pitched murmur. It is heard in patients with pulmonary regurgitation.

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• Dock’s Murmur: It is heard in aortic stenosis patients.

• Millwheel Murmur: It is a loud machinery like churning or splashing sound. This sound is a sign of air embolism.

• Cole-Cecil Murmur: It is heard in aortic insufficiency cases.

• Carvallo’s Sign: It is used in patients with tricuspid regurgitation.

• Gallavardin Phenomenon: It is known to occur in patients with aortic stenosis.

What Are the Causes of Heart Murmurs?

Generally, a heart murmur may be labeled as innocent murmurs and abnormal murmurs. An innocent murmur is noticed in healthy individuals, pregnant women, exercising individuals, and newborn babies. An abnormal murmur can be seen in heart diseases and congenital disorders.

What Are Innocent Murmurs?

Innocent murmurs are soft systolic murmurs heard in individuals without any cardiac abnormalities. They are due to increased blood flow through the ventricular tracts. Innocent murmurs may be heard:

• In children, it is known as Still’s murmur.

• In adults, it will be seen in individuals over 50 years of age.

What Are the Symptoms of Abnormal Murmurs?

Sometimes there might not be any symptoms. The abnormal sounds will be identified by a doctor with the help of a stethoscope. However, there are some specific signs of heart problems. They are:

• Cyanosis - It is the appearance of bluish coloration in the fingers and lips.

• Swelling in the legs.

• Enlargement of the liver.

• Sudden weight gain.

• Dizziness.

• Chronic cough.

• Shortness of breath.

• Profuse sweating.

• Chest pain.

• Fainting.

• Loss of appetite.

What Are Functional Murmurs?

These are murmurs caused by dilatation of heart chambers or vessels. It can also be caused due to the increased flow of blood. They are two types:

• Systolic murmurs.

• Diastolic murmurs.

What Is Systolic Murmur?

The heart functions by performing both contraction and relaxation. Systole is the contraction occurring in the heart. Systole identifies the maximum pressure exerted on the arteries. The murmur, which occurs during any part of the systolic phase is known as a systolic murmur. There are four types of systolic murmurs. They are:

1. Early systolic murmurs.

2. Mid-systolic murmur. The mid-systolic murmur is also known as ejection systolic murmur.

3. Late systolic murmurs.

4. Pansystolic murmurs.

What Is Diastolic Murmur?

Diastole is the relaxation phase occurring in the heart. Diastole refers to the minimum pressure in the arteries. Murmurs, which occur during any part of diastole, is known as a diastolic murmur. There are three types of diastolic murmurs,

1. Early diastolic murmurs.

2. Mid-diastolic murmurs.

3. Late diastolic murmurs. It is also known as pre-systolic murmurs.

What Are the Grading Systems of Murmurs?

1. Systolic Murmur Grading:

• I – Very soft. (heard in quite a room).

• II – Soft.

• III – Moderate.

• IV – Loud with a thrill.

• V – Very loud with thrill (heard with a stethoscope).

• VI - Very loud with thrill (heard even when a stethoscope is slightly away from the chest wall).

2. Diastolic Murmur Grading:

• Very soft.

• Soft.

• Loud.

• Loud with thrill.

What Are the Risk Factors?

• Having a family history of heart problems.

• Health issues during pregnancy.

• Uncontrolled diabetes, hypertension, endocarditis, rheumatic fever, and systemic lupus erythematosus.

• Taking alcohol, drugs, and medications during pregnancy.

What Are Continuous Murmurs?

A continuous murmur is the one that begins in the systole and extends through the whole of the diastole. It is generated by the flow of blood from a zone of high resistance to a zone of low resistance. In continuous murmur, the abnormal sounds will be heard during both systole and diastole. The continuous murmurs can be categorized according to the flow and pressure of the blood.

How Is It Diagnosed?

Diagnosis requires clinical examination by a doctor with a stethoscope. In order to diagnose and confirm other diseases, the doctor might recommend you for a chest X-ray, electrocardiogram, echocardiogram, and cardiac catheterization test.

Chest X-ray: The chest X-ray is used to replicate the images of the heart, blood vessels, and lungs. This diagnostic X-ray can be used to find any deformity or malformations.

Electrocardiogram: This is a noninvasive procedure. The electrical signals can be used to record the rhythm of the heart.

Echocardiography: Echocardiography is used to identify the abnormal heart valves that are calcified and hardened.

What Are the Treatment Options?

Treatment might involve medications and surgical techniques.

Medications:

Your doctor might recommend anti-coagulant, diuretics, statins, beta-blockers, and angiotensin-converting enzyme inhibitors according to your health condition.

Surgery:

Depending on your condition, your doctor might plan for open-heart surgery, balloon valvuloplasty, annuloplasty, and aortic valve replacement procedures.

Open Heart Surgery: This surgery involves correcting the cardiac abnormalities by opening the chest and viewing the heart.

Balloon Valvuloplasty: It is a surgical procedure that is done to replace a particular valve of the heart. In this procedure, the surgeon inserts a small and narrow tube called a catheter into a blood vessel in the groin. It then advances through the aorta into the heart. As the catheter reaches the narrow valve, the doctor enlarges the balloon using the inflation procedure. After the valve has been opened, the balloon can be deflated. The catheter is removed later.

Annuloplasty: In an annuloplasty procedure, the doctor uses an artificial ring. This ring helps in tightening of the tissue surrounding the valve. This surgery is used to correct the deformities in heart valves.

Conclusion:

Heart murmurs are an important indicator of abnormalities in the heart. Though these can be best diagnosed with the help of a stethoscope, other accompanying signs can help in identifying the need to visit a healthcare provider. Being cautious of the signs can aid in early diagnosis and can help prevent complications.

Are you facing any related symptoms? Call a doctor online.

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