A heart murmur is a sound caused by turbulent blood flow moving through the heart’s chambers or valves. The necessary precautions and specific things to avoid depend entirely on the underlying diagnosis. Murmurs are categorized as either “innocent” or “pathological.” An innocent murmur is harmless, often temporary, and requires few restrictions. A pathological murmur signals an underlying issue, such as a damaged heart valve, and requires specific avoidance measures to prevent complications.
Physical Activities and Excessive Strain
Individuals diagnosed with a pathological heart murmur, particularly one caused by significant valve disease, often need to modify their approach to physical activity. The primary concern is avoiding exercises that cause an abrupt or excessive increase in blood pressure and subsequent strain on the heart structures. High-intensity activities and competitive sports may be restricted because they can lead to a rapid deterioration of heart function or trigger dangerous arrhythmias in certain conditions.
Specific types of exercise that should be approached with caution or avoided include isometric exercises, such as heavy weightlifting. This is because isometric contractions cause a sustained rise in blood pressure, placing a disproportionate load on the heart’s chambers and valves. For those with severe valve stenosis, where the blood flow is already restricted, vigorous exertion can limit the heart’s ability to supply enough oxygenated blood to the body, leading to symptoms like chest pain or fainting.
It is important to seek a specific exercise prescription from a cardiologist, as restrictions vary greatly depending on the severity and type of valve issue. Moderate-intensity aerobic exercise is generally encouraged for most people with heart conditions to maintain cardiovascular fitness. Staying well-hydrated and avoiding exercise in extreme heat or cold is also advised, as dehydration and temperature extremes can further stress the cardiovascular system.
Dietary Habits and Substance Use
Managing a pathological heart murmur often involves careful consideration of dietary choices and limiting substances that affect heart function. Excessive caffeine consumption is discouraged because it is a stimulant that can trigger palpitations or irregular heart rhythms, which may be poorly tolerated by a compromised heart. Since the amount considered “excessive” varies, patients should note any increase in heart rate or symptoms following caffeine intake.
Alcohol consumption should be heavily limited or avoided. Chronic, heavy drinking can weaken the heart muscle, a condition known as cardiomyopathy, which complicates existing valve disease. Alcohol also contributes to weight gain and elevates blood pressure, putting extra strain on the heart.
If hypertension is a co-existing factor, reducing sodium intake is necessary. High salt levels cause the body to retain fluid, increasing blood volume and making the heart work harder. Furthermore, complete avoidance of smoking, nicotine products, and illicit stimulant drugs is necessary. Nicotine and stimulants drastically increase heart rate and blood pressure, creating an acute and severe strain on compromised heart valves or chambers. A heart-healthy diet that limits processed foods, added sugars, and saturated fats supports overall cardiovascular function and reduces the risk of further heart complications.
Infection Prevention and Medical Procedures
The risk of infective endocarditis (IE) is a significant concern for individuals with pathological heart murmurs, especially those involving damaged or artificial valves. IE is a serious infection of the heart lining or valves, usually caused by bacteria entering the bloodstream. Prevention begins with maintaining meticulous dental and oral hygiene, including regular professional cleanings and check-ups, to reduce the presence of bacteria in the mouth.
Before any invasive medical or dental procedure, it is imperative to inform all healthcare providers, including dentists and surgeons, about the heart murmur diagnosis and any related heart conditions. For patients at the highest risk of adverse outcomes from IE, prophylactic antibiotics may be prescribed before specific dental procedures. High-risk patients include those with:
- A prosthetic heart valve.
- A history of infective endocarditis.
- Certain types of congenital heart disease.
These specific dental procedures involve manipulation of the gums or the periapical region of teeth, where bacteria are most likely to enter the bloodstream.
The decision to use antibiotic prophylaxis is based on current guidelines that reserve it only for high-risk patients undergoing procedures that breach the oral mucosa. Antibiotics are generally not recommended for non-dental procedures like genitourinary or gastrointestinal tract procedures unless a pre-existing infection is present. Open communication with your cardiologist is the best way to determine if you require preventative antibiotic treatment.