What are the causative factors for heart murmurs?

Question

Hello doctor,

My echocardiogram shows possible severe mitral valve regurgitation. I recently saw a relatively new physiologist who was great, but did not have the time or experience to fully answer my questions. I am feeling apprehensive about the possible cause. Last year, I experienced viral symptoms, shortness of breath, chest pain, and low-grade fevers for about four months, following an acute illness with a fever of 42°C. At the time, I was referred to a rheumatologist due to suspected SLE, which has since been ruled out. How unlikely is it that I could have had undiagnosed endocarditis or rheumatic fever as the underlying cause? The echocardiogram was prompted after my partner, who is a doctor, noticed a new heart murmur while lying with their head on my chest.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

It is very reasonable to be concerned. Severe mitral regurgitation, especially with a new murmur and a prior history of prolonged viral-like illness with high fever, shortness of breath, and chest pain, does raise the question of missed subacute endocarditis or rheumatic carditis, even if SLE (systemic lupus erythematosus) was ruled out. Endocarditis can be culture-negative or subtle, especially if antibiotics are taken early. Rheumatic fever is less common in high-income countries but still possible, especially with strep exposure. A TEE (transesophageal echo) and inflammatory markers, along with a detailed history, can help clarify the cause. It is good your murmur was caught; early follow-up with me is key.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.