One definition of the word murmur is “to express one’s discontent in a subdued manner.” So, it makes sense that a heart murmur is often a soft-spoken signal that something may be going on in the heart. The heart does not always shout to get our attention like it does with a heart attack. Sometimes it quietly whispers to those who will listen that there might be an issue. The murmur itself is not the problem, rather, the murmur is telling us to look for one.

Some murmurs are called innocent or benign. These are murmurs when the heart is normal, but the blood is flowing over the valves rapidly which causes a sound. About 40 to 45% of children will have a murmur at some point in their life. No treatment is needed for these murmurs and children will often outgrow them, but up to 10% of them do persist into adulthood.

Murmurs that indicate more serious issues are often associated with valve disorders in the heart. The valves are the areas that open when the chamber of the heart beats and close when the heart is between beats, to allow the chambers to relax and refill with blood. Sometimes a valve does not fully close, or it will balloon backward and allow blood to backflow across the valve. This back flow causes a murmur. This is called valve prolapse that leads to blood regurgitation or “regurg,” which requires medical attention.

A different type of murmur is caused by mitral or aortic valve stenosis. Stenosis is when the valve does not fully open, so the same amount of blood is forcing itself through a narrower opening in the same amount of time as it does in a normal valve. That extra pressure causes the murmur because the heart must work harder to push the blood through the valve. Over time if this is untreated it can lead to damage of the heart muscles.

The most common murmur is aortic sclerosis, which happens when the aortic valve develops scarring, stiffening, or thickening. This can occur with age or after infections such as rheumatic fever or endocarditis. This is not dangerous by itself, but if it progresses to stenosis, it can be cause for concern.

Often when a doctor hears a murmur, we may want to get a better look with a special ultrasound called an echocardiogram to see if we can find the cause of the noise. Once the cause is found, a follow up plan can be made.

When the heart whispers, we must always listen. By doing so, we may avoid further discontent, forcing the heart to raise its voice over a larger problem.

Jill Kruse, D.O., is part of The Prairie Doc team of physicians and currently practices family medicine in Brookings, South Dakota. For more information, visit www.prairiedoc.org.

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