A scenario we often see in the Cardiology Department looks like this: a 30-year-old comes into my office after having some chest pain, shortness of breath, or related symptoms. The patient was told by their parents that they had a heart murmur as a child but barely recall the details. “I think they mentioned a heart murmur?” They don't associate the sudden onset symptoms with this congenital condition because they seemed completely healthy for years.

A Common Occurrence in Children

The challenge is that heart murmurs -- an unusual or extra sound to a heart beat -- are common in children. Heart murmurs are not necessarily cause for alarm.


There are two types of heart murmurs: innocent (harmless) and abnormal (potentially harmful).

Most children diagnosed have innocent heart murmurs and can live unaffected lives without symptoms of this diagnosis. For some patients, like the 30-year-old presenting with symptoms, the murmur can be abnormal and caused by a congenital heart defect. The defect can be present at birth but go undetected or unmonitored.

Murmurs heard through a stethoscope are dynamic. That means that we can hear a murmur but it can come, go, and change depending on a patient’s blood vessels, pressure, lung health or chest wall differences.

Diagnosing heart murmurs can be difficult, which is why they’re frequently missed early on. Listening for any abnormality is one thing, but knowing what you are listening for and knowing when it is time to take extra precautions or start treatment, requires special expertise.

When a Heart Murmur Becomes Cause for Concern

When undetected or not closely followed, an abnormal heart murmur can create cardiovascular problems later in life or early on depending on the issue. Some valve abnormalities may:

  • Not let enough blood through (stenosis), causing the heart to not pump normally
  • Not close properly, causing leaking (regurgitation)

Symptoms of Heart Valve Disease

  • Shortness of breath
  • Fatigue
  • Inability to maintain activity
  • Lightheadedness
  • Swollen ankles, feet or belly
  • Difficulty breathing when lying flat to sleep
  • Palpitations or fluttering heart beats

Some valve problems can cause both. Other congenital conditions, like a “hole in the heart”, or septal defect, and cardiac shunts can also impact blood flow to the heart and heart chamber size over time causing murmurs.

Most people with heart valve disease in the United States don’t have symptoms for very long periods in their life, and often present to a cardiologist (heart doctor) incidentally. The 30-year-old patient described above will present symptoms like shortness of breath, fatigue, or heart palpitations. They aren’t sure the cause or why they have suddenly started experiencing symptoms. This can be frustrating and sometimes is a source of significant fear and anxiety.

Steps You Can Take to Prevent Cardiovascular Complications

Taking early steps to understand a heart murmur symptoms or diagnosis is important to maintaining strong heart health and preventing major problems later on. Today, cardiovascular physicians are trained specifically in heart valve disease, preventive care, and screening for adult congenital heart disease (ACHD).

What to do if you have been diagnosed with a heart murmur and experience symptoms of heart valve disease:

  • Talk to a primary care physician. If you’ve been told you have a heart murmur in the past ask your PCP if you should see a cardiologist, particularly if you have developed new shortness of breath, palpitations, or chest pain symptoms.
  • See a cardiologist. If you have been diagnosed with a “hole in your heart” or mitral valve prolapse or a bicuspid valve, make an appointment with a cardiologist to see what the status is and whether it needs follow up.

At The Polyclinic, we help patients build strong cardiac preventive care action plans. We can quickly assess, quantify, and guide patients through follow-up and intervention. We partner with patients to take steps early to make smart decisions to maintain heart health.

Knowledge is power for all of us. Regular visits with your primary care doctor and your cardiologist, if needed, help better predict, plan, and prevent cardiovascular complications later in life. Work with your care team to understand your health conditions, treatment options, and take control of your health.


February 10, 2016 | by The Polyclinic