What is a heart murmur and why is it bad?
In: 5
Heart beats every time it pumps blood. Murmur is the blood leaking from the heart because the valve doesn’t close all the way. That reduces pressure, forcing your heart to work harder to get blood to places it needs to go. Over time, that hurts the heart further.
Like your 5?
“A heart murmur is a funny sound
That comes from your heart and can be found
By a doctor with a stethoscope, listening in
To the way that your blood flows within
Sometimes it’s nothing to fear
But other times it might be clear
That there’s a problem with your heart you see
And you’ll need to visit a cardiologist, don’t you agree?
Heart murmurs can happen for many a reason
Like a fever or pregnancy, without a good reason
But sometimes it’s a sign of something more
Like a hole in your heart or a valve that’s a bore
So listen up now and don’t be coy
If you have a heart murmur, don’t be coy
See a doctor and get it checked out
And everything will work out, no doubt!”
So, some parts of cardiology still use some old terms from before modern tools were invented. Like, for example, an echocardiogram. Echocardiograms are like an ultrasound. High frequency sound is passed through the chest to reconstruct an image of the heart. Or a cardiac catheter. Here a tube is passed up along the huge blood vessels that go to your legs up into the heart to take direct readings of the pressure changes inside the heart itself. But old school cardiologists mostly used a stethoscope and a few other tools, an EKG, and a few other tools.
A stethoscope just allows them to listen to the way the heart sounds right now. A normal healthy heart should have a double thump sound as first one side contracts and then the other. To act as a pump the heart allows blood to flow into an opening, called a chamber, and squeezes down on it. But if you have an opening on both ends of the chamber that will squeeze the blood out both ends. So we put in a one way valve to keep the blood from flowing the wrong direction. Think of it as being similar to a swinging door where you can push on it and it swings in one way, but the frame won’t let it swing the other way. The valves are like tiny flaps of skin that work the same way.
Okay, so if those flaps of skin – the valves – don’t close all the way what happens? Blood flows the wrong way. There’s a leak. That leak will often create a sound because you have pressurized liquid squirting through it. It tends to sound like a murmur when this happens. Think of the normal thump thump sound of a heart with some low rumbling along with the thumps.
So, why a murmur bad? In of itself, it isn’t. It can mean a leaky valve but it automatically doesn’t equal there is a problem. If you take a lot of small children and listen to their chests there will often be a murmur even when they are healthy. Why? Because we’re living creatures and not everything is perfect. A small imperfection may lead to an imperfect seal and some blood leaks through. When they are older and their chest is bigger and there is more material to block that slight murmur gets harder to hear. But when they are still tiny and the stethoscope is closer to the heart? It’s more noticeable.
Which is why a heart murmur is usually treated as an indicator that something MAY be wrong and it isn’t usually the diagnosis in of itself. It’s used to indicate a need to determine the source. Some people have a heart murmur and nothing is really done. Their valves leak but doing surgery is not advised. The leak (or regurgitation) is so minor it’s considered a bigger risk to do the surgery. Sometimes a murmur is the first sign something really bad is about to happen.
A heart should have 2 sounds. This is from valves closing during the heart pumping blood.
A murmur is an extra sound due to an issue with one (or more) of the four valves. Generally speaking, the issue can either be due to a weak valve (which causes back flow of blood) or a thickened/hardened valve (which makes the heart work harder to get the blood moving forward)
Murmurs are not always bad, it depends on their severity. Rather, how weak or thickened they are. But typically they cause the heart to work harder so that it can push the same amount of blood forward. Excess strain on the heart is not good
There’s many types of heart murmurs and not all are necessarily “bad” but may require further work-up with an echocardiogram (heart ultrasound) or a visit with a heart doctor.
Any murmur heard with a stethoscope represents turbulent blood flow and most are associated with heart valves. There are 4 valves in total – the tricuspid, mitral, aortic, and pulmonary valves. If the valve is scarred, has calcium deposits, or is otherwise narrowed for any reason, blood doesn’t flow smoothly and that can be heard as a murmur.
Valves can also be “leaky” and allow blood to flow backwards (this is called regurgitation in medical speak). Again, thus causes turbulence which can be heard on exam with a stethoscope
Finally, some people are born with a “hole in the heart” which is a defect in the heart tissue that allows blood to flow from one chamber to another; the most common is a ventricular septal defect where some blood flows from the left ventricle to the right instead of being pumped through the aorta. Small ones are often left alone but larger ones sometimes need surgical repair at some point, usually in childhood.
Same principle applies – turbulent blood flow creates the murmur
Murmurs become “bad” when the valve or defect is so great that not enough blood flows in the correct direction and leads to heart failure with blood backing up in the lungs, liver, body tissues, etc. You can also have poor delivery of oxygenated blood to vital organs such as the brain, contributing to fatigue and fainting among other symptoms. If medications and fluid management doesn’t help, severe cases may require surgery to replace or repair the culprit valve.
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