Heart Murmurs: Why You Shouldn’t Ignore That Heartbeat’s Extra Noise

The heart beats as its valves open and close to allow blood to flow. But a heart murmur is an extra noise heard during a heartbeat which is caused when blood does not flow smoothly. 

There are different types of heart murmurs. Some can be harmless or functional, while others can signal something abnormal such as heart valve disease. Either way, everyone should get checked regularly by their physician even if symptoms are few -- if any.

Jonathan Fialkow, M.D., chief population health officer for Baptist Health and chief of cardiology at Miami Cardiac & Vascular Institute.

Heart valve disease occurs if one or more of the heart valves — the tricuspid, pulmonary, mitral, and aortic valves — do not open fully or they allow blood to leak back into the chambers. Heart valves can have three basic kinds of problems: regurgitation, stenosis (narrowing), and atresia (lacking an opening for blood to flow through).

Questions arise when you doctor hears that swooshing sound of a heart murmur, explains Jonathan Fialkow, M.D., chief of cardiology at Baptist Hospital and Chief Population Health Officer at Baptist Health. “Is it an innocent murmur, which means of no danger, or an abnormal murmur, which may be a sign of a pathological condition? Is it a heart valve problem or a structural defect that could lead to real trouble?” asks Dr. Fialkow.

Recently, Dr. Fialkow hosted a Baptist HealthTalk Podcast featuring Nish Patel, M.D., interventional cardiologist at Baptist Health Miami Cardiac & Vascular Institute.

The heart murmur could be related to many different conditions, said Dr. Fialkow.

"In fact, it could be related to some congenital issues, things that people are born with, not all of which become dangerous," explains Dr. Fialkow. "Some are age related. One of the benefits of seeing a cardiologist is having the knowledge of what's causing the murmur with an assessment of one's age and other aspects of their health. It's not just a matter of you don't need something, but we could also kind of anticipate and predict if and when someone might need something done to the heart valve. "

Dr. Patel also stresses the importance of seeing a cardiologist before symptoms evolve or worsen.

Nish Patel, M.D., interventional cardiologist at Baptist Health Miami Cardiac & Vascular Institute.

"Whenever a primary care physician hears a murmur in a patient, they should refer the patient to a cardiologist because we can find out if they had some sort of a congenital valve disease, and we would be able to hear a murmur in the early stage of their disease," said Dr. Patel. "And then we can follow them regularly to make sure to identify severe stenosis when symptoms are in the early stages -- which include fatigue, difficulty breathing. And we can address them before it can impact their heart muscle."

What are the symptoms of a heart murmur? Heart murmurs don’t often cause symptoms. When they do, these symptoms may include:feeling weak or tired; shortness of breath, especially with exercise; chest pain; a fast, pounding or skipping heartbeat; swollen ankles, feet, or belly (abdomen); and feeling dizzy or faint.

Over the past several years, there have been significant advances in treating heart valves that have focused on minimally invasive, catheter-based procedures, which generally ensure quick and smoother recoveries compared to outright “open-heart” surgeries.

“Whenever anybody has a murmur, they should have a cardiological evaluation with a physical examination,” explains Dr. Patel. “And later, there should be an objective assessment in the echocardiogram so that we can understand if it is an innocent murmur. It could be a flow murmur we usually see in a young individual and also in kids. Or it could be a pathologic murmur which can come from valvular heart disease.”