Heart murmurs and other sounds Health Article

Common Causes

Significant murmurs can be caused by:

• Aortic regurgitation
• Aortic stenosis
• Hypertrophic cardiomyopathy (idiopathic hypertrophic subaortic stenosis)
• Mitral regurgitation - acute
• Mitral regurgitation - chronic
• Mitral stenosis
• Pulmonary regurgitation (backflow of blood into the right ventricle, caused by failure of the pulmonary valve to close completely)
• Pulmonary stenosis
• Tricuspid regurgitation
• Tricuspid stenosis

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

• Anomalous pulmonary venous return (an abnormal formation of the pulmonary veins)
• Atrial septal defect (ASD)
• Coarctation of the aorta
• Patent ductus arteriosus (PDA)
• Ventricular septal defect (VSD)

Children often have murmurs as a normal part of development. These murmurs do not require treatment, and may include:

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

What to expect at your health care provider's office

The health care provider will usually discover a heart murmur during a physical examination. You may or may not have been aware of its presence. The physical examination will include careful attention to heart sounds.

The doctor may ask the following questions:

• Have other family members had murmurs or other abnormal heart sounds?
• Is there any family history of heart problems?
• What other symptoms do you have, such as:
  • Bluish skin color (cyanosis)
  • Chest pain
  • Distended neck veins
  • Fainting (syncope)
  • Liver enlargement
  • Lung sound changes
  • Shortness of breath
  • Swelling
  • Weight gain

Diagnostic testing to determine the cause of a "new" murmur or other abnormal heart sound may include:

• Chest x-ray
• ECG
• Echocardiography

References

Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsever; 2007:chap 62.

Fang JC, O'Gara PT. The history and physical examination: an evidence-based approach. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsever; 2007:chap 11.