Content

Introduction

Introduction

The blood flows in the heart and its passage is regulated by the opening and closing of the heart valves which, making this movement, produce a dry sound (heart tones) that the doctor listens (ausculta) with the phonendoscope.

The flow of blood can also cause a hiss-like noise called a heart murmur under some conditions.

Heart murmurs can be present from birth (congenital) or develop later in life. Often, they are completely meaningless (in which case they are saidinnocent) and do not need any care. However, they can be a sign of a heart problem that needs to be investigated and monitored over time. Other heart murmurs, on the other hand, may require a series of checks to rule out the presence of heart defects or diseases. Care, if necessary, is directed to the cause that generated them.

Symptoms

Symptoms

Normally a benign heart murmur (innocent) is not perceived. Even the breathabnormal it may not cause any disturbance (symptom) and be discovered by chance by the doctor, listening to the heart with the phonendoscope, during a cardiological visit.

The presence of the following signs or disorders (symptoms) may indicate a heart problem:

  • chronic cough
  • sudden weight gain
  • shortness of breath
  • enlarged liver
  • enlarged neck veins
  • poor appetite and growth retardation (in infants or young children)
  • intense sweating even with little or no effort
  • fainting
  • bluish color of the skin, especially at the fingertips and lips

When to see your doctor

Most heart murmurs are not a sign of disease; if you suspect that you suffer from it, however, it is advisable to contact your family doctor who will be able to check if it is a murmurinnocent, which does not require any treatment, or if clinical and instrumental investigations are necessary.

Causes

Causes

Heart murmurs can be:innocentAnd abnormal.

A person with ainnocent breath has a normal heart. This type of murmur is common in infants and children.

Aabnormal murmur it is indicative of a more serious heart problem. In children they are generally caused by a heart disease present at birth (congenital); in adults they are more often linked to reduced heart valve function, a condition that develops with advancing age.

Innocent heart murmurs

Innocent heart murmurs occur when blood circulation in the heart is faster than normal.

This can happen for:

  • physical activity
  • pregnancy
  • fever
  • anemia (insufficient number of red blood cells in the blood)
  • excessive functioning of the thyroid gland (hyperthyroidism)
  • rapid growth, as in adolescence

Abnormal heart murmurs

Heart murmur in babies is commonly congenital in nature and is due to a heart defect present from birth.

Birth defects that cause heart murmurs are:

  • holes or deviations of blood in the heartAlso known as septal defects, based on their size and location, they can be mild or severe. Blood diversions occur when there is an abnormal passage of blood between the heart chambers (the atria or ventricles) or between blood vessels
  • heart valve abnormalities, the valve does not allow sufficient blood passage (stenosis) or does not close perfectly and the blood flows back (insufficiency) as occurs in the case of mitral valve prolapse; these anomalies are present from birth but are sometimes recognized in the first years of life

Other causes of abnormal heart murmurs are infections and other conditions that damage the structures of the heart and are more common in older children and adults. Eg:

  • calcification of the valve, with aging, the valves can harden or thicken and, consequently, narrow, making it more difficult for the blood to pass: the vortex caused by the slowing of the flow is the cause of the heart murmur
  • endocarditisThis infection of the inner lining of the heart and valves occurs when bacteria spread through the blood and make their way to the heart. If the infection is not treated, it can significantly damage the heart valves
  • rheumatic fever, is a serious condition that can arise as a result of an "infection caused by a bacterium, lostreptococcus, in cases where the treatment of the infection has started late or is not completed

There are risk factors that increase the chance of a heart murmur developing. Between these:

  • family history of valvular heart disease, if related family members have had valvular heart disease the likelihood of having a heart defect or murmur increases
  • medical conditions, such as untreated high blood pressure (arterial hypertension), hyperthyroidism, infection of the inner lining of the heart (endocarditis), high blood pressure in the lungs (pulmonary hypertension), hormone secretion by cancer cells (carcinoid syndrome), hypereosinophilic syndrome (a rare disease), some chronic diseases (lupus erythematosus and rheumatoid arthritis), weakened heart muscle or a history of rheumatic fever

Risk factors for the baby are:

  • some diseases present during pregnancy, such as poorly controlled diabetes and rubella infection, can increase the child's risk of developing congenital heart disease or a murmur
  • some medicines, illegal drugs, or alcoholtaken by the mother during pregnancy can cause coronary heart disease in the fetus

Diagnosis

Diagnosis

Heart murmurs are generally detected by the doctor during a visit by listening to the heart with an instrument, the stethoscope, which allows you to evaluate the characteristics of the murmur.

To understand if the heart murmur isinnocent orabnormal, the doctor considers:

  • intensity, there is a scale from 1 to 6 (6 is the highest value)
  • the appearance of noise in relation to heart sounds and its duration, if the murmur is felt when the heart fills with blood (diastolic murmur) or during the heartbeat (continuous murmur) further investigation is required
  • part of the chest where it is felt, if it is also felt in the neck or back
  • possible variation or disappearance of the noise, changing body position or the type of activity that is taking place

The attending physician during the visit inquires about the present and past general state of health, investigates the presence of other signs or disorders (symptoms) relating to heart problems and asks if other members of the family have had murmurs or other heart diseases.

Further medical examinations

If your doctor suspects a heart murmur isabnormal, it may require some investigations which include:

  • chest x-ray, examination that shows a "picture of the heart, lungs, and blood vessels. May reveal the presence of an enlarged heart, which can cause heart murmur.
  • electrocardiogram (ECG), an examination that records the rhythm and electrical activity of the heart. Normally it is performed in a hospital or outpatient clinic, it takes only a few minutes and is not painful; during its development the metal plates calledelectrodes, connected with cables to the ECG device, are positioned on the arms, legs and chest. Each time the heart beats, it produces electrical signals and the ECG device records them on paper
  • echocardiogram, ultrasound scan that produces a "moving image of the heart. The echocardiogram allows you to visualize heart blood flow, valve movements, and heart muscle activity. It can, therefore, show valves that are thickened (calcified) or not. they are able to regulate the passage of blood (regurgitation), or other heart defects
  • cardiac catheterization, a test that consists of introducing a tube (catheter) into a vein or artery in the leg or arm to reach the heart. In this way, pressures in the atria and ventricles (chambers of the heart) can be measured and a dye can be injected which, being visible on the x-ray, will help the doctor see the blood flow through the heart, blood vessels and valves and to check for any defects. This test is generally used where other investigations have not yielded results
Complications

Complications

Heart murmur complications can only be serious if it is a murmurabnormal due to birth defects (congenital) or untreated diseases.

Complications may include the risk of thrombus (clots) formation in the heart chambers up to heart failure.

It is always advisable to contact your doctor who will provide the appropriate indications to identify the cause and understand how to intervene to avoid complications.

Therapy

Therapy

A heart murmurinnocent usually it doesn't need any treatment because the heart is normal. If it is caused by fever or hyperthyroidism, it will disappear as the disease heals.

If the puff isabnormal no treatment may be needed and your doctor may ask for periodic check-ups. If, on the other hand, the therapy is necessary, his choice will depend on the heart problem underlying the murmur and may include the use of drugs or surgery.

Medicines

The medication your doctor will prescribe depends on the type of heart problem. Among the medicines used:

  • drugs that prevent blood clots (blood thinners), such as aspirin, warfarin or clopidogrel. Anticoagulants prevent the formation of blood clots in the heart and, therefore, the appearance of a heart attack or stroke
  • diuretics, medicines that help eliminate excess fluids from the body: help treat other conditions that can aggravate a heart murmur, such as high blood pressure
  • ACE inhibitors, drugs that lower blood pressure. In fact, high blood pressure can worsen the condition that causes the heart murmur
  • statins, medicines that help lower blood cholesterol: elevated cholesterol can aggravate some heart valve problems and even heart murmurs
  • beta blockers, drugs that lower heart rate and blood pressure

Surgery

Some heart valve problems cannot be treated with medication alone, so your doctor may recommend that they be repaired or replaced.

Prevention

Prevention

Not much can be done to prevent a heart murmur, but it must be considered that it is not a disease in itself. In the case of children, in most cases the murmur disappears as they grow; in adults, with the improvement of the condition that caused it.

In the past, doctors recommended taking antibiotics before undergoing tooth cleaning, or surgery, to prevent a bacterial infection from affecting the inner lining of the heart (infective endocarditis). Today, antibiotics are no longer recommended for everyone but only for people with a high risk of developing "infective endocarditis" and for those who have an artificial valve or congenital heart defects.

Bibliography

Bibliography

Mayo Clinic. Heart murmurs (English)

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