What is a heart murmur and why is it bad?
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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.
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