A heart murmur is an extra or unusual sound heard during the heartbeat, often described as a whooshing or swishing noise. This sound arises from turbulent blood flow within or near the heart. While a heart murmur requires careful evaluation, it does not automatically prevent an individual from undergoing surgery. Medical professionals assess each situation to determine the appropriate course of action, prioritizing patient well-being.
Types of Heart Murmurs
Heart murmurs fall into two main categories: innocent and abnormal. Innocent murmurs are common and typically do not indicate an underlying heart condition. These harmless sounds can occur when blood flows faster than usual through the heart, which might happen during pregnancy, exercise, a fever, or due to anemia. Innocent murmurs often resolve on their own, especially in children, and usually do not require medical treatment.
In contrast, abnormal murmurs signal an underlying heart issue that warrants closer attention. These can result from problems with the heart valves, such as narrowing (stenosis) or leakage (regurgitation), which disrupt normal blood flow. Other causes include structural heart problems present from birth, like holes in the heart walls, or conditions acquired later in life, such as infections of the heart lining (endocarditis) or hypertrophic cardiomyopathy.
Pre-Surgical Assessment
Evaluating a heart murmur before surgery involves a comprehensive assessment to understand its cause and potential implications. This process begins with a thorough medical history review and a physical examination, where a doctor listens to the heart to note the murmur’s pitch, timing, location, and volume.
If a murmur is detected, several diagnostic tests may be performed. An echocardiogram uses sound waves to create detailed images of the heart’s chambers, valves, and blood flow patterns, identifying structural abnormalities like valve stenosis, regurgitation, or septal defects. An electrocardiogram (ECG or EKG) records the heart’s electrical activity, revealing conditions such as chamber enlargement or irregular heartbeats.
A chest X-ray provides information about the heart’s size, shape, and lungs. In some cases, a cardiac catheterization may be performed; this invasive procedure measures pressures and visualizes blood flow within the heart. A stress test evaluates how the heart functions under physical exertion. A cardiologist, a heart specialist, reviews these results, providing clearance or specific recommendations for the surgical team.
Surgical Risk Management
When a heart murmur is present, managing surgical risk involves a collaborative effort among the surgical team, including the surgeon, anesthesiologist, and cardiologist. Continuous monitoring of heart function is standard during the procedure, allowing the team to promptly address any changes in cardiac activity.
The choice and administration of anesthesia are carefully considered and adjusted based on the specific type and severity of the heart murmur. Certain murmurs, such as severe aortic stenosis, can significantly increase perioperative risk in non-cardiac surgery. In some situations, antibiotic prophylaxis may be recommended to prevent infective endocarditis. This is typically advised for individuals with specific high-risk cardiac conditions, including those with prosthetic heart valves, a history of infective endocarditis, or certain congenital heart defects. Guidelines for antibiotic use have become more specific over time, focusing on the highest-risk patients and procedures.
Surgical Decision Making
The final decision regarding surgery for a patient with a heart murmur is based on several factors: the specific characteristics and severity of the heart murmur, the type and urgency of the planned surgical procedure, and the patient’s overall health status. A mild, innocent murmur may not pose significant concerns, allowing surgery to proceed with standard precautions.
If the murmur indicates a more substantial heart condition, the medical team may consider delaying the planned surgery to first address the underlying cardiac issue. This could involve medical management or a heart procedure, such as valve repair or replacement, to improve heart function and reduce surgical risks. In rare instances where the heart condition makes traditional surgery too risky, alternative, less invasive treatments like transcatheter aortic valve replacement (TAVR) may be explored for conditions like aortic stenosis.