Common Causes
Heart palpitations. Pain or tightness in your chest. Shortness of breath. Syncope or weakness. How is a heart murmur diagnosed? A healthcare provider can diagnose a heart murmur by listening to your heart. A murmur makes an abnormal swishing sound. Your provider listens to your heart with a stethoscope from different places on your chest and back.
Related Conditions
A murmur means blood is flowing abnormally across your heart valves. A murmur may mean there’s a problem with your heart. But heart murmurs are also present in healthy people who don’t have a heart problem (called “innocent” heart murmurs). Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission.
How do you know if you have a heart murmur?
Echocardiogram. This test is the main test used to determine the cause of a heart murmur. An echocardiogram uses ultrasound waves to create detailed images of your heart's structure and function.
What does it mean to have a murmur?
Diagnosis. You or your child will need more tests to find out what the problem is. Murmurs that occur when the heart is emptying (systolic) generally are innocent heart murmurs that don't cause health issues, but sometimes they may reflect a heart condition.
What tests are used to diagnose heart murmur?
What do you need to know about a systolic murmur?
How should you determine whether a murmur is systolic or diastolic?
Systolic murmurs occur between the first heart sound (S1) and the second heart sound (S2). Diastolic murmurs occur between S2 and S1. In addition, timing is used to describe when murmurs occur within systole or diastole.
How do you know if you have heart murmur?
Tests that can determine the cause of a heart murmur are: Chest X-ray: A chest X-ray takes pictures inside your chest to find any structural problems. Echocardiogram: Echocardiogram (also called an echo) uses sound waves to create images of your heart's valves and chambers.
How are heart murmurs characterized?
Murmurs are described by their timing in the cardiac cycle, intensity, shape, pitch, location, radiation and response to dynamic maneuvers. Using the aforementioned criteria, a clinician can accurately characterize the nature of a murmur and communicate their findings in a precise manner.
What test detects heart murmur?
“Most heart murmurs are diagnosed by your primary care physician,” said Krajacic. If a murmur is detected, your doctor will typically order an echocardiogram, a non-invasive test that produces a detailed moving picture of the heart and its valves and gives baseline information.
What is the most common cause of a heart murmur?
A heart murmur is an extra noise heard during a heartbeat. The noise is caused when blood does not flow smoothly through the heart. Heart murmurs can be innocent (harmless) or abnormal (caused by a heart problem). Some causes are fever, anemia, or heart valve disease.
What is a heart murmur sound like?
A heart murmur is a sound caused by blood flow within the heart. Instead of 'lub-dub', the heartbeat may have an added sound like a hum, a whoosh or a rasp. The cause of the whooshing sound is the vibration of blood as it moves through the heart, which is normally undetectable by stethoscope.
What are the four types of heart murmurs?
What Are the Different Types of Murmurs?Systolic murmur. A heart murmur that occurs during a heart muscle contraction. ... Diastolic murmur. A heart murmur that occurs during heart muscle relaxation between beats. ... Continuous murmur. A heart murmur that occurs throughout the cardiac cycle.
What are 3 abnormal heart sounds?
Abnormal heart sounds are called heart murmurs....What is an abnormal heart sound (heart murmur)?a rasping.a whooshing.a blowing.
Where do you hear heart murmurs?
Pulmonary and aortic murmurs Sound from the aortic valve is often transmitted to the carotid and can be heard by placing a stethoscope over the carotid bifurcation. Pulmonary stenosis will produce a flow murmur that gets louder then softer (crescendo-decrescendo) during systole.
How do doctors treat heart murmurs?
Surgeries for heart murmurs often include valve repair and valve replacement. These surgeries treat the underlying valve problems in your heart that are causing the murmur. If you do need surgery, your cardiothoracic surgeon will try to make sure your surgery is as minimally invasive as possible.
Does a murmur show on an ECG?
Heart murmur diagnosis Doctors are likely to first pick up heart murmurs with a stethoscope. They may order further tests to check whether it's an innocent or abnormal murmur. These tests can include: electrocardiogram (ECG) — a machine that records the heart's electrical activity.
Can heart murmur go away?
Often, children are born with heart murmurs that go away once they're adults. Similarly, some pregnant women develop heart murmurs because they have more blood volume passing through the heart valves. These murmurs usually go away after pregnancy.
Can you feel a heart murmur in your chest?
Myth #2: You can tell it's a murmur just by listening Although a heart murmur doesn't feel like anything, per se, she says the symptoms you may feel are related to the underlying cause.
Can heart murmurs go away?
Many innocent murmurs become hard to hear as children grow older. Most go away on their own. Pregnant women also sometimes have innocent heart murmurs because the body makes extra blood during pregnancy. Other heart murmurs are caused by problems with the heart.
How do they fix a heart murmur?
Surgeries for heart murmurs often include valve repair and valve replacement. These surgeries treat the underlying valve problems in your heart that are causing the murmur. If you do need surgery, your cardiothoracic surgeon will try to make sure your surgery is as minimally invasive as possible.
How common is a heart murmur?
About 10% of adults and 30% of children (most between the ages of 3 and 7) have a harmless murmur produced by a normal heart.
How are murmurs described?
Murmurs are described by their timing in the cardiac cycle, intensity, shape, pitch, location, radiation and response to dynamic maneuvers. Using the aforementioned criteria, a clinician can accurately characterize the nature of a murmur and communicate their findings in a precise manner. Timing. The timing of a murmur is crucial ...
Where do murmurs radiate?
While murmurs are usually most intense at one specific listening post, they often radiate to other listening posts or areas of the body. For example, the murmur of aortic stenosis frequently radiates to the carotid arteries and the murmur of mitral regurgitation radiates to the left axillary region.
What is a systolic murmur?
Systolic murmurs can be classified as either midsystolic (aka systolic ejection murmurs or SEM), holosystolic (pansystolic), or late systolic. A midsystolic murmur begins just after the S1 heart sound and terminates just before the P2 heart sound, so S1 and S2 will be distinctly audible.
Why is a murmur high pitched?
Pitch. A murmur will be high-pitched if there is a large pressure gradient across the pathologic lesion, and low-pitched if the pressure gradient is low. For example, the murmur of aortic stenosis is high-pitched since there is usually a large pressure gradient between the LV and the aorta.
What is the grade of a diastolic murmur?
Diastolic murmurs are graded on a scale of 4. This is a completely subjective grading scale. Once again, grade I murmurs may not be audible to some; however, grade IV murmurs are audible very easily.
Does regurgitation cause diastolic or systolic murmurs?
Conversely, regurgitation of the same valves will result in a diastolic murmur, as blood flows backward through the diseased valve when ventricular pressures drop during relaxation. Regarding the mitral and tricuspid valves, stenosis would result in a diasto lic murmur and regurgitation a systo lic murmur. Other murmurs will be discussed in their respective sections. A complete discussion of valvular heart disease is found elsewhere.
Is a murmur systolic or diastolic?
The timing of a murmur is crucial to accurate diagnosis. A murmur is either systolic, diastolic or continuous throughout systole and diastole. Remember: Systole occurs between the S1 and S2 heart sounds, while diastole occurs between S2 and S1.
What is the sound of a heart murmur?
Heart murmur. A heart murmur is a swishing sound heard when there is turbulent or abnormal blood flow across the heart valve.
Can a murmur be present without a heart condition?
Murmurs can be present without any medical or heart conditions. Two common examples include:
How do you know if you have a heart murmur?
An abnormal heart murmur may cause the following signs and symptoms, depending on the cause of the murmur: Skin that appears blue, especially on your fingertips and lips. Swelling or sudden weight gain. Shortness of breath.
What is the sound of a heart murmur?
Heart murmurs are sounds — such as whooshing or swishing — made by turbulent blood in or near your heart. Your doctor can hear these sounds with a stethoscope. A normal heartbeat makes two sounds like "lubb-dupp" (sometimes described as "lub-DUP") when your heart valves are closing.
Why do older people have abnormal heart murmurs?
In older children and adults, causes of abnormal heart murmurs include infections and conditions that damage the structures of the heart. For example:
Why do children murmur?
In children, abnormal murmurs are usually caused by structural problems of the heart (congenital heart defects). Common congenital defects that cause heart murmurs include: Holes in the heart. Known as septal defects, holes in the heart may or may not be serious, depending on the size of the hole and its location. Cardiac shunts.
Can a heart murmur go away?
While there's not much you can do to prevent a heart murmur, it is reassuring to know that heart murmurs are not a disease and are often harmless. For children, many murmurs go away on their own as children grow. For adults, murmurs may disappear as the underlying condition causing them improves.
Is a heart murmur a sign of heart disease?
An innocent heart murmur is not a sign of heart disease and doesn't need treatment. Abnormal heart murmurs require follow-up testing to determine the cause. Treatment is directed at the cause of your abnormal heart murmur.
Is a murmur a normal heart?
A person with an innocent murmur has a normal heart. This type of heart murmur is common in newborns and children.
How do you know if you have a heart murmur?
Heart murmurs are usually detected when your doctor listens to your heart using a stethoscope during a physical exam.
What test is used to determine if a heart murmur is abnormal?
If your doctor thinks the heart murmur is abnormal, you or your child may need additional tests, including: Echocardiogram. This test is the main test used to determine the cause of a heart murmur. An echocardiogram uses ultrasound waves to create detailed images of your heart's structure and function.
Why does my heart murmur go away?
If an innocent murmur is caused by an illness, such as fever or an overactive thyroid (hyperthyroidism), the murmur will go away once that condition is treated. An abnormal heart murmur is closely monitored by your doctor over time.
What is an innocent heart murmur?
Tests need to be done to find the cause. A murmur that occurs when the heart is emptying (systolic murmur) generally is an innocent heart murmur. Innocent heart murmurs aren't a sign of heart disease and don't require treatment.
Why do you need antibiotics for heart murmurs?
Doctors used to recommend that most people with abnormal heart murmurs take antibiotics before visiting the dentist or having surgery to prevent bacteria from getting into the lining of the heart (infective endocarditis).
Does statin help with heart murmurs?
Statins help lower your cholesterol. Having high cholesterol seems to worsen some heart valve problems, including some heart murmurs. Beta blockers. These drugs lower your heart rate and blood pressure.
What are the characteristics of a systolic murmur?
These characteristics are intensity (loudness), frequency (pitch), quality, duration, configuration, primary location (point of maximum intensity), and site(s) of radiation. The intensityof a heart murmur is most effectively gauged using the system originally proposed by Levine. Grade 1 refers to a murmur so faint that it can be heard only with special effort. A grade 2 murmur is faint, but is immediately audible. Grade 3 refers to a murmur that is moderately loud, and grade 4 to a murmur that is very loud. A grade 5 murmur is extremely loud and is audible with one edge of the stethoscope touching the chest wall. A grade 6 murmur is so loud that it is audible with the stethoscope just removed from contact with the chest wall. In general, murmurs with an intensity of grade 4 or higher are accompanied by a palpable thrill. Frequencyor pitchrelates to the velocity of blood at the site of origin of the murmur and is designated as high, medium, or low. In general, the higher the velocity, the higher the pitch of the murmur. Blood flow from a high-pressure chamber to a chamber with lower pressure possesses high velocity; hence the associated murmurs are high pitched. Murmurs that emanate from areas of stenosis where velocity is lower are typically low to medium pitched. Qualityrefers to the tonal effect of the murmurs. Frequently used descriptors are blowing, musical, squeaking, whooping, honking, harsh, rasping, grunting, and rumbling. Durationrefers to the portion of the cardiac cycle that the murmur occupies. Murmurs may be systolic, diastolic, or continuous. Systolic murmurs may be early systolic, midsystolic, late systolic, or holosystolic. Early systolic murmurs begin with the first heart sound and extend to middle or late systole. Midsystolic murmurs begin following a murmur-free interval in early systole and end with a murmur-free interval (of variable duration) in late systole. Late systolic murmurs begin during the last half of systole and may or may not extend to the second heart sound. Holosystolic murmurs begin with the first heart sound and extend to or through the second heart sound. The configurationof a murmur refers to its shape. To a large degree it is a function of intensity and duration. Crescendo murmurs progressively increase in intensity. Decrescendo murmurs progressively decrease in intensity. With crescendo—decrescendo murmurs (diamond or kite-shaped murmurs), a progressive increase in intensity is followed by a progressive decrease in intensity. Plateau murmurs maintain a relatively constant intensity. Locationrefers to the point on the precordium where the murmur is heard with maximum intensity. Many systolic murmurs are audible over multiple areas of the precordium. Localizing their point of maximum intensity may aid greatly in determining their site of evolution. Not all heart murmurs radiate. Defining the sites of radiationfor those that do is important in determining the underlying cause of the murmur.
How are murmurs created?
Murmurs are created by disturbance of laminar blood flow (i.e., turbulence), but turbulence per se does not produce adequate acoustic force to be audible at the chest wall. The most widely accepted theory concerning the generation of murmurs was popularized by Bruns and incorporates the concept of vortex shedding. Vortices are tiny eddies created by an obstruction to the laminar flow of blood. The concept of vortex shedding can be simplified by employing a familiar analogy—a boulder protruding through the surface of a fast-moving stream. The undisturbed water flows without interruption until it hits the boulder. The boulder causes the stream to separate and generate vortices, or tiny eddies that move in a spiral fashion and are shed in the general direction of the flow of the stream. As the vortices are shed, they leave in their place wakes, which are areas of relatively "still water." Water rapidly moves in to fill the wakes left by vortex shedding. The sound that one hears when water is rushing around the boulder is generated by the filling of wakes left by the shedding of vortices.
What is a pulmonic ejection murmur?
Functional systolic ejection murmurs include pulmonic flow murmurs in patients with either normal or increased pulmonary artery or aortic flow. The most common functional systolic ejection murmur in adults is probably a variant of Still's murmur, the so-called innocent murmur of childhood. It is a short, buzzing, pure, medium-pitched, nonradiating, midsystolic murmur heard best along the upper left sternal border. It is thought to result from vibrations set in motion by the pulmonic valve. A less frequently encountered functional pulmonic flow murmur, occurring predominantly in children and adolescents, emanates from the root of the pulmonary artery. It is midsystolic and similar in location, but less uniform than Still's murmur. It is high pitched, often blowing in nature, and is similar to the flow murmur heard in patients with the "straight-back syndrome." Functional systolic ejection murmurs may also result from hyperdynamic blood flow over a normal pulmonic or aortic valve. Such murmurs are commonly associated with high cardiac output states such as thyrotoxicosis, anemia, infection, fever, arteriovenous fistula, beriberi, the hyperkinetic heart syndrome, or pregnancy. They may also be audible after exercise or with anxiety.
How to perform auscultation?
The clinician should use a stethoscope with plastic or rubber tubing 25 to 30 cm (10 to 12 in) long . The stethoscope should be equipped with a stiff diaphragm and a shallow bell. The patient should be examined in the recumbent, sitting, and left lateral decubitus positions. The principal areas of interest are the primary aortic area (second and third intercostal space at the left sternal border), the tricuspid area (fourth intercostal space at the left sternal border), and the mitral area (cardiac apex). Levine and Harvey have recommended that auscultation begin at the cardiac apex, then proceed along the left sternal border from the tricuspid area to the pulmonic area and finally to the aortic area. The clinician should also auscultate the right parasternal region, the right and left base of the neck, the right and left carotid arteries, the left axilla, and the interscapular area. These are areas to which systolic heart murmurs may radiate or from which extracardiac sounds simulating systolic heart murmurs may emanate. The clinician should alternate use of the diaphragm and bell at each location. Before attempting to detect and characterize a systolic murmur, the clinician should define the first and second heart sounds in order to locate systole accurately.
Where is a murmur audible?
A murmur is a series of vibrations of variable duration, audible with a stethoscope at the chest wall, that emanates from the heart or great vessels. A systolic murmur is a murmur that begins during or after the first heart sound and ends before or during the second heart sound.
Is a systolic murmur considered a pulmonic murmur?
The best example of this is an ostium secundum atrial septal defect. Here, the systolic murmur is a nondescript pulmonic flow murmur, but the diagnosis is secured by detecting fixed and wide splitting of the second heart sound. Attention to other elements of the cardiovascular examination may also provide important clues to the severity of the abnormality causing the murmur.
Is supravalvular aortic stenosis murmurable?
Supravalvular aortic stenosis also produces a murmur indistinguishable from valvular aortic stenosis. The murmur is typically most intense over the primary aortic area and radiates to both carotid arteries, but the amplitude of the carotid and brachial pulses may be unequal (greater on the right side) due to the orientation of the jet of blood that traverses the area of stenosis. An ejection click is typically absent. Supravalvular aortic stenosis usually becomes apparent early in childhood, and may be associated with mental retardation and elfin facies.
What is the configuration of a murmur?
Configuration: Note the configuration of the murmur, defined as its intensity over time. Some murmurs grow louder over time (crescendo murmurs), some grow less intense over time (decrescendo murmurs), others first rise and then fall in intensity (crescendo-decrescendo murmurs).
Where is the best place to hear a murmur?
For example, some murmurs heard best at the apex radiate to the axilla or even to the posterior thorax. Similarly some murmurs heard along the left sternal border radiate to the carotids.
What causes a heart murmur?
Heart Murmurs. Heart murmurs are caused by turbulent blood flow and are distinguished from heart sounds by their longer duration. While many heart murmurs arise from structurally normal hearts, narrowed or leaky heart valves are a common pathologic cause. When evaluating a heart murmur, several characteristics should be noted.
How to rate the intensity of a murmur?
Rate the intensity of the murmur using a 6-point scale. Record this as a fraction where the numerator refers to the greatest intensity of the murmur heard and the denominator refers to the scale being used. For example an easily discernible murmur would be recorded as 3/6 and reported as "three over six."
Is a murmur systolic or diastolic?
Diastolic murmurs may be early diastolic, mid-diastolic, or late diastolic. While systolic murmurs may be heard in patients with a perfectly normal heart, diastolic murmurs are classically associated with valvular pathology.
What are the characteristics of a heart murmur?
There are different classifications of heart murmurs. Characteristics of murmurs must be specified according to their intensity and sound frequency, as well as location in the chest and location in the cardiac cycle – if they occur during systole or diastole. Furthermore, the volume of blood responsible ...
What is the quality of a murmur?
It usually goes in the same direction as the blood flow. Finally, depending on its tone, it can be low or high. And quality is a special characteristic of breathing. Meaning it can be musical, blowing, or running, among others.
What are the different types of heart murmurs?
The most frequently-used classification system was first introduced in 1933 by Levine. He relied on intensity, a term explained above, to be able to classify this cardiac disorder. According to Levine, there are 6 different degrees of heart murmurs depending on their intensity: 1 1st grade: barely audible. Listening to several cardiac cycles of the patient may be the only way to hear them. 2 2nd grade: these are soft, but audible. 3 3rd grade: these are moderate, and palpable vibrations in the chest wall from the passage of blood. 4 4th grade: these are intense murmurs that are accompanied by a thrill. 5 5th grade: these are very intense murmurs. They can even be heard by barely touching the chest with the edge of the stethoscope. 6 6th grade: a stethoscope isn’t needed to hear these murmurs because they’re so intense.
How many degrees of heart murmurs are there?
According to Levine, there are 6 different degrees of heart murmurs depending on their intensity: 1st grade: barely audible. Listening to several cardiac cycles of the patient may be the only way to hear them. 2nd grade: these are soft, but audible. 3rd grade: these are moderate, and palpable vibrations in the chest wall from the passage of blood.
Why isn't a stethoscope needed in 6th grade?
6th grade: a stethoscope isn’t needed to hear these murmurs because they’re so intense.
How many auscultation points are there on the anterior side of the chest?
Therefore, there are 6 auscultation points on the anterior side of the chest to identify a murmur: In the second intercostal space on the right hand side. From the second to the fifth intercostal space on the left hand side. In the fifth intercostal space in the left mid-clavicular line.
What is it called when you hear a heart murmur?
In other words, they are sounds that appear during the heartbeat cycle that produce turbulent blood flow in or near the heart. People use stethoscopes to hear heart murmurs. In addition, you can be born with it, or it can happen at any point in life. If you are born with them, they are called congenital heart murmurs.
