A heart murmur is a whooshing or swishing sound occurring between the normal “lub-dub” of the heart sounds. This extra sound is caused by turbulent blood flow within the heart or its major vessels. A heart murmur is a physical finding, not a disease in itself. Therefore, “fixing” a heart murmur involves identifying and treating the underlying cause of the turbulent flow. Many murmurs are harmless and require no intervention, while others signal a structural problem needing medical or surgical correction.
Differentiating Functional Murmurs from Pathological Murmurs
The first step in addressing a heart murmur is determining its nature: whether it is innocent (functional) or abnormal (pathological). Functional murmurs are temporary and benign, resulting from blood flowing faster than usual through normal heart structures. This increased flow occurs during periods of high cardiac output, such as during fever, intense exercise, anemia, or pregnancy, and typically disappears once the underlying condition resolves.
Pathological murmurs are caused by a structural problem within the heart, often involving the valves or the walls separating the chambers. These murmurs indicate an issue that may require treatment to prevent complications. To distinguish between the two, a doctor listens to characteristics like loudness, timing, pitch, and location. An echocardiogram, which uses sound waves to image the heart’s structure and blood flow, is often the definitive test for confirming a structural abnormality.
Treating Underlying Structural Heart Conditions
When a murmur is pathological, it points to a structural issue that must be addressed to eliminate turbulent blood flow. Common structural causes involve heart valves that are narrowed (stenosis) or leaky (regurgitation). For instance, aortic stenosis, where the aortic valve stiffens and narrows, creates a loud murmur as blood is forced through the restricted opening.
Other causes include congenital defects, such as a ventricular septal defect (VSD) or atrial septal defect (ASD). These are holes in the walls between the heart chambers that cause blood to shunt abnormally, resulting in a distinct murmur. The “fix” for the murmur is the repair of the primary heart disease, such as repairing or replacing the faulty valve or closing the septal defect. This physical correction restores laminar blood flow and quiets the murmur.
Medical Management and Watchful Waiting
For individuals with mild or moderate structural heart disease, the initial approach is often “watchful waiting” combined with medical therapy. Watchful waiting involves regular monitoring, often including annual echocardiograms, to track the defect’s progression and heart muscle function. Intervention is typically reserved until the condition worsens, symptoms develop, or the heart muscle shows signs of strain.
Medical management aims to slow disease progression and reduce symptoms without physical repair. Diuretics are frequently prescribed to remove excess fluid and ease the heart’s workload, especially in cases of regurgitation. Beta-blockers and ACE inhibitors may be used to manage blood pressure and slow the heart rate, reducing stress on the damaged valve. Anticoagulants are sometimes necessary to prevent dangerous blood clots, particularly in patients with associated arrhythmias like atrial fibrillation.
Lifestyle modifications are also a significant part of management. These include reducing salt intake to control fluid retention, maintaining a healthy weight, and following a tailored exercise plan recommended by a cardiologist. These non-invasive measures can postpone or prevent the need for more invasive procedures by optimizing cardiovascular health.
Surgical and Minimally Invasive Interventions
When medical therapy is insufficient or the structural defect is severe, definitive intervention is required to physically correct the problem and fix the source of the murmur. Traditional open-heart surgery involves accessing the heart through a full sternotomy to perform valve repair or replacement. Valve repair is often preferred, especially for the mitral valve, as it preserves the patient’s native valve tissue and function.
If the valve is too damaged, replacement involves inserting either a mechanical valve (requiring lifelong blood thinners) or a bioprosthetic (tissue) valve (which typically has a limited lifespan). Newer, less invasive techniques have revolutionized the treatment of many structural heart defects. Procedures like Transcatheter Aortic Valve Replacement (TAVR) allow a new valve to be delivered via a catheter through a small incision, often in the groin, without opening the chest. Similarly, catheter-based devices, such as the MitraClip for mitral regurgitation or specialized closure devices for septal defects, can repair the structural flaw, eliminating turbulent flow and the associated heart murmur.