A Cardiac Assessment of a Murmur

The heart is one of the body's major organs. Its job is to circulate blood throughout the cardiovascular system in order to supply body tissue with nutrients and oxygen. When evaluating a patient's heart health, physicians listen to the sound made by the heart as it pumps blood. If there is an abnormality in the formation of the heart, the sound it makes is different than that made in the hearts of normal patients. This difference in sound is called a murmur and can be used by cardiologists to diagnose specific malformations.

The Human Heart

• Consisting of muscle tissue, nerves, blood vessels and minimal fat, the human heart is divided into four chambers. These chambers, or compartments, are separated by valves that keep blood from flowing backwards. In normal individuals, blood is sent from the heart to the lungs, where it is oxygenated, and then returns to the heart to be pumped to the body. Doctors listening to healthy hearts can hear the blood being pumped through these valves during the normal course of circulation.

Heart Murmur

• Any extra or unusual sound made by the heart as it beats is considered a heart murmur. These unexpected sounds may come in the form of whooshing or squishing sounds and are heard in addition to the normal “lub-DUP” sounds associated with a typical heart. The normal sound is made by the valves opening and then closing. Abnormal formations or leaks within the heart cause these noises to be distorted in a specific way, relative to the malformation.

Assessment

• Physicians routinely check heart health by listening for murmurs using a stethoscope. Because the ability to distinguish between different murmurs is a specialized ability, general practice physicians who detect heart murmurs refer their patients to cardiologists for further evaluation. Though there are more definitive means of assessing heart murmurs, such as an echocardiogram which uses sound waves to visualize the heart’s construction, cardiologists first listen to the heart to categorize the murmur. Heart murmurs can be grouped by either the time in which they occur during the cycle of a heartbeat, or by the severity. If grouped by their timing, murmurs are called either systolic or diastolic murmurs, depending on whether they are heard during systole or diastole. Another means of classification is to refer to the murmur as being innocent or abnormal. Innocent heart murmurs are actually not uncommon and are indicative of small leaks in valves that do not pose a threat to patient health. Abnormal murmurs are more severe in nature and require medical attention because they are the result of heart disease.

Treatment

• A heart murmur is not a disease. Rather, murmurs are signs that there may be an underlying problem with the heart. In the case of innocent murmurs, no treatment is necessary, as the murmur is caused by a harmless abnormality. However, abnormal murmurs caused by some type of heart disease need to be treated. Congenital heart disease is the name given to a heart defect present at birth. In case of severe congenital heart disease, the problem presents itself shortly after birth and is immediately addressed by cardiologists. Consequently, an abnormal heart murmur found after infancy is likely to be only mild or moderate in severity. Examples include leaking valves and constricted vessels, or perforations. In some cases, the cause of a murmur may be treated with medications such as blood thinners or alpha-blockers, which alleviate the strain in the heart by altering blood pressure. Another option is for the patient to undergo cardiac catheterization to repair mild malformations. The most drastic means of treatment would be heart surgery, perhaps to receive a valve implant.

Outlook

• As with any medical case, situational circumstances impact the outcome for a given patient. However, because most heart murmurs are found to be innocent, a patient may carry their abnormality with them for the duration of a long, active, and happy life. In cases requiring treatment, the prognosis for success is excellent. Using pharmaceuticals and cardiac catheterization are remarkably successful treatments with minimal risk. Heart surgery does pose the greatest risk, with success rates relying on the specific procedure and experience of the surgical team.