Heart murmur: need to worry?

By Cristiano Antonino On Feb 12, 2023

It can happen that you go to the cardiologist for a check-up and are told that ‘there is a heart murmur’. Panic. Here come the worst thoughts, the worst conjectures and you find yourself looking for news about this infamous heart murmur

In reality, it is not, for the most part, a serious disorder.

About 50 per cent of adults who make a cardiological examination suffer from it.

However, despite the doctor’s reassurances, the patient still has fears.

So let’s see what a heart murmur is, how it manifests itself and when there is cause for concern.

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Heart murmur, what it is and how it manifests itself

Let’s start by saying that a heart murmur is not a medical condition that is cause for concern, if there are clearly no other complaints.

In reality, heart murmur is not even a pathology so much as a condition.

The term therefore describes a condition, a situation in which the flow of blood put into circulation by the heart is no longer silent, but rather produces a noise.

The flowing blood pumped by the heart muscle in a normal condition is silent, in medical terms it is called laminar flow.

If, however, the flow is more turbulent, i.e. it no longer flows silently through the walls of the blood ducts, but instead generates a noise, as of air passing through a perforation, then we are in the presence of so-called heart murmur.

This noise can only be perceived with a phonendoscope, and again, it is not a real pathology, although in some cases it can be a sign of a serious disorder.

So when should we be concerned?

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Symptomatology of heart murmur

A heart murmur gives no obvious symptoms, in fact, as has been said, the most frequent way in which it is discovered is during a cardiological examination.

The heart murmur tends to be benign, hence the name innocent heart murmur, especially at a young age.

In this case, there are no further symptoms, nor will they appear later on, which is why one can lead a completely normal life, also because in most cases in which a heart murmur is diagnosed at a young age, it tends to disappear as one grows up.

If there are associated symptoms, on the other hand, the heart murmur may be symptomatic of some pathology.

For example, this is the case if one notices shortness of breath or an increased heartbeat even at rest.

Another symptom that should not be underestimated is skin turning blue, especially the periphery, i.e. the fingers and toes and the lips.

Other important symptoms are sudden weight gain, chest pains, chronic coughing, enlarged liver, dizziness, fainting, and poor resistance to exertion.

In all these cases, it is important to consult a doctor.

The main causes of heart murmur

Heart murmur arises, as we have seen, when the flow of blood inside the vessels is not regular but rather turbulent, to put it very simply.

But what causes this ‘turbulence’? In reality, there are several causes, from valve insufficiency to a congenital problem, but in most cases these are not major problems.

Heart murmurs from valvular insufficiency are quite common: the valves do not open or close in the natural and regular way to ensure that blood flows in the correct direction.

If there is a failure of these structures, a condition of blood reflux can occur, which produces a sound and is perceived as a heart murmur.

However, there are numerous physiological and anatomical changes that can be the cause of a heart murmur, so it is up to the doctor to make an assessment of the case and all the necessary investigations, usually an examination using instruments such as a cardiac holter.

One case where one need not worry is due to mitral valve prolapse, in fact it is not even defined as a true heart murmur.

Prolapse gives the valve a bulging, sail-like shape that protrudes into the atrium.

The blood passage generates a noise almost like a click.

The valve is very easily incontinent and this can generate a retrograde murmur that can be heard during auscultation.

When not to worry at all

As we have seen, if the murmurs are benign, there is no need to worry.

This is the case when the phenomenon is diagnosed at a young age. Suffice it to say that in children, heart murmurs are very frequent, between 50-60% of cases, and they are mostly what are called innocent murmurs.

These are therefore physiological murmurs, due to the anatomical structure where the valves have a smaller calibre than the cardiac chambers, which increases the speed of the blood flow that generates the noise as it passes through.

When to worry and go to the doctor

Malignant heart murmurs are caused by specific pathologies.

If they have existed since birth, i.e. are congenital, they should be monitored periodically.

One of the best-known congenital conditions is hypertrophic cardiomyopathy, a disorder with specific genetic characteristics that vary from patient to patient.

In the case of a related pathology, medical consultation is always necessary.

It will then be the investigations that determine the seriousness of the situation and consequently the various pharmacological or surgical solutions.

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Heart murmurs and physical activity

One of the most frequently asked questions, in the event of a heart murmur, is whether or not one can engage in physical activity.

Let us say here in a very general way that if it is a benign heart murmur there are absolutely no contraindications, on the contrary, physical activity is always recommended.

There is therefore no reason to prevent a child diagnosed with a heart murmur from practising sport.

In the case of related pathologies, however, it is a good idea to talk to the doctor because excessive sedentariness can lead to other ailments, so it will be up to the doctor to assess whether and how much physical activity can be carried out and on what terms.

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