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Heart murmurs

Chest sounds - murmurs; Heart sounds - abnormal; Murmur - innocent; Innocent murmur; Systolic heart murmur; Diastolic heart murmur

A heart murmur is a blowing, whooshing, or rasping sound heard during a heartbeat. The sound is caused by turbulent (rough) blood flow through the heart valves or near the heart.

Considerations

The heart has 4 chambers:

  • Two upper chambers (atria)
  • Two lower chambers (ventricles)

The heart has valves that close with each heartbeat, causing blood to flow in only one direction. The valves are located between the chambers.

Murmurs can happen for many reasons, such as:

  • When a valve does not close tightly and blood leaks backward (regurgitation)
  • When blood flows through a narrowed or stiff heart valve (stenosis)

There are several ways in which your health care provider may describe a murmur:

  • Murmurs are classified ("graded") depending on how loud the murmur sounds with a stethoscope. The grading is on a scale. Grade I can barely be heard. An example of a murmur description is a "grade II/VI murmur." (This means the murmur is grade 2 on a scale of 1 to 6).
  • In addition, a murmur is described by the stage of the heartbeat when the murmur is heard. A heart murmur may be described as systolic or diastolic. (Systole is when the heart is squeezing out blood and diastole is when it is filling up with blood.)

When a murmur is more noticeable, the provider may be able to feel it with the palm of the hand over the heart. This is called a "thrill".

Things the provider will look for in the exam include:

  • Does the murmur occur when the heart is resting or contracting?
  • Does it last throughout the heartbeat?
  • Does it change when you move?
  • Can it be heard in other parts of the chest, on the back, or in the neck?
  • Where is the murmur heard the loudest?

Causes

Many heart murmurs are harmless. These types of murmurs are called innocent murmurs. They will not cause any symptoms or problems. Innocent murmurs DO NOT need treatment.

Other heart murmurs may indicate an abnormality in the heart. These abnormal murmurs can be caused by:

  • Problems of the aortic valve (aortic regurgitation, aortic stenosis)
  • Problems of the mitral valve (chronic or acute mitral regurgitation, mitral stenosis)
  • Hypertrophic cardiomyopathy 
  • Pulmonary regurgitation (backflow of blood into the right ventricle, caused by failure of the pulmonary valve to close completely)
  • Pulmonary valve stenosis
  • Problems of the tricuspid valve (tricuspid regurgitation, tricuspid stenosis)

Significant murmurs in children are more likely to be caused by:

Multiple murmurs may result from a combination of heart problems.

Children often have murmurs as a normal part of development. These murmurs DO NOT need treatment. They may include:

  • Pulmonary flow murmurs
  • Still's murmur
  • Venous hum

What to Expect at Your Office Visit

A provider can listen to your heart sounds by placing a stethoscope on your chest. You will be asked questions about your medical history and symptoms, such as:

  • Have other family members had murmurs or other abnormal heart sounds?
  • Do you have a family history of heart problems?
  • Do you have chest pain, fainting, shortness of breath, or other breathing problems?
  • Have you had swelling, weight gain, or bulging veins in the neck?
  • Does your skin have a bluish color?

The provider may ask you to squat, stand, or hold your breath while bearing down or gripping something with your hands to listen to your heart.

The following tests may be done:

References

Fang JC, O'Gara PT. History and physical examination: an evidence-based approach. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 10.

Goldman L. Approach to the patient with possible cardiovascular disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 45.

Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2017;135(25):e1159-e1195. PMID: 28298458 pubmed.ncbi.nlm.nih.gov/28298458/.

Swartz MH. The heart. In: Swartz MH, ed. Textbook of Physical Diagnosis: History and Examination. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 14.

  • Heartbeat

    Animation

  •  

    Heartbeat - Animation

    The heart has four chambers and four main blood vessels that either bring blood to the heart, or carry blood away. The four chambers are the right atrium and right ventricle and the left atrium and left ventricle. The blood vessels include the superior and inferior vena cava. These bring blood from the body to the right atrium. Next is the pulmonary artery that carries blood from the right ventricle to the lungs. The aorta is the body's largest artery. It carries oxygen-rich blood from the left ventricle to the rest of the body. Beneath the tough fibrous coating of the heart, you can see it beating. Inside the chambers are a series of one-way valves. These keep the blood flowing in one direction. Dye injected into the superior vena cava, will pass through all the heart's chambers during one cardiac cycle. Blood first enters the heart's right atrium. A muscle contraction forces the blood through the tricuspid valve into the right ventricle. When the right ventricle contracts, blood is forced through the pulmonary semilunar valve into the pulmonary artery. Then it travels to the lungs. In the lungs, the blood receives oxygen then leaves through the pulmonary veins. It returns to the heart and enters the left atrium. From there, blood is forced through the mitral valve into the left ventricle. This is the muscular pump that sends blood out to the rest of the body. When the left ventricle contracts, it forces blood through the aortic semilunar valve and into the aorta. The aorta and its branches carries the blood to all the body's tissues.

  • Heart - section through the middle

    Heart - section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart - section through the middle

    illustration

  • Heart valves

    Heart valves - illustration

    The valves of the heart open and close to control the flow of blood entering or leaving the heart.

    Heart valves

    illustration

  • Heartbeat

    Animation

  •  

    Heartbeat - Animation

    The heart has four chambers and four main blood vessels that either bring blood to the heart, or carry blood away. The four chambers are the right atrium and right ventricle and the left atrium and left ventricle. The blood vessels include the superior and inferior vena cava. These bring blood from the body to the right atrium. Next is the pulmonary artery that carries blood from the right ventricle to the lungs. The aorta is the body's largest artery. It carries oxygen-rich blood from the left ventricle to the rest of the body. Beneath the tough fibrous coating of the heart, you can see it beating. Inside the chambers are a series of one-way valves. These keep the blood flowing in one direction. Dye injected into the superior vena cava, will pass through all the heart's chambers during one cardiac cycle. Blood first enters the heart's right atrium. A muscle contraction forces the blood through the tricuspid valve into the right ventricle. When the right ventricle contracts, blood is forced through the pulmonary semilunar valve into the pulmonary artery. Then it travels to the lungs. In the lungs, the blood receives oxygen then leaves through the pulmonary veins. It returns to the heart and enters the left atrium. From there, blood is forced through the mitral valve into the left ventricle. This is the muscular pump that sends blood out to the rest of the body. When the left ventricle contracts, it forces blood through the aortic semilunar valve and into the aorta. The aorta and its branches carries the blood to all the body's tissues.

  • Heart - section through the middle

    Heart - section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart - section through the middle

    illustration

  • Heart valves

    Heart valves - illustration

    The valves of the heart open and close to control the flow of blood entering or leaving the heart.

    Heart valves

    illustration

Tests for Heart murmurs

 
 

Review Date: 7/7/2020

Reviewed By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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