Dr Dinesh Nair, a cardiologist at Mount Elizabeth Hospitals, shares when heart murmurs can become a cause of concern.
What are heart murmurs?
Heart murmurs are unusual sounds detected through the use of a stethoscope during a heart cycle. A heart cycle consists of a systolic phase, where blood is ejected from the left heart ventricle, and a diastolic phase, where the left heart ventricle relaxes.
Thankfully, most murmurs are not serious. However, some murmurs can be caused by conditions that may require immediate medical attention. The difficulty is often trying to figure out which ones require urgent attention. This is where a cardiologist's opinion and assessment is often very important.
When heard through a stethoscope, normal heart sounds will produce a 'lub-dub' sound whereas murmurs can resemble a whooshing or swishing noise of different intensities. They can indicate turbulent or abnormal blood flow across the heart valves or other holes in the heart, and can be heard from the chest wall, apex of the heart or the neck.
Types of heart murmurs
There are 2 types of heart murmurs. Heart murmurs can either be physiological in nature or caused by other illnesses.
- Physiological murmurs can be caused by pregnancy, overactive thyroid glands, fever or high blood pressure. They are harmless and will naturally be resolved after the condition has been addressed. Harmless or benign murmurs are often also called flow murmurs. Many patients have these without any underlying cause.
- Secondary causes of heart murmurs include a previous bacterial infection in the blood, rheumatic fever, age-related degenerative changes or an enlarged heart. Unborn fetuses often have a hole in the heart and it usually closes after birth. However, there are times when the hole does not close and this can pose a problem later in life. These are often called congenital heart defects, and can range from mild to severe. Abnormal heart murmurs in adults are usually due to secondary causes affecting the valves.
When to worry about heart murmurs?
While many people with heart murmurs do not experience any symptoms, some may experience chest pains, shortness of breath, dizziness and excessive sweating despite minimal or no exertion.
Although most heart murmurs are not a call for concern, the difficulty often lies in figuring out which ones require urgent attention. When consulting your cardiologist on heart murmurs, it would be best to inform your doctor of any pre-existing health or hereditary conditions. Once a murmur has been properly evaluated, your cardiologist can then plan subsequent steps to be taken.
How are heart murmurs evaluated?
An echocardiogram, which is used to evaluate heart murmurs, will show if the murmurs are due to physiological or secondary causes. Your cardiologist may then order an electrocardiogram (ECG) and a chest x-ray. The former is used to reflect any heart rhythm abnormalities as well as any enlargement of the heart, while the latter is helpful to see if the heart has been enlarged due to the cause of the murmurs.
Sometimes, a cardiac catheterisation is needed to further evaluate the cause of the heart murmurs. This procedure involves inserting a small tube into the veins or arteries to make certain measurements.
How is treatment carried out?
Once the cause has been established, your cardiologist may recommend blood tests, medications and/or surgical interventions. If the murmurs are due to a diseased or damaged valve, you may be advised to undergo surgical interventions such as valve repair or replacement. Valves can be repaired or replaced through open-heart surgery or through minimally invasive techniques that require small access sites and leave no significant scars.
The transcatheter aortic valve implantation/replacement (TAVI/R) procedures, in particular, have been known to produce good results. Holes in the heart can also be closed using open or minimally invasive techniques.
Once a murmur has been properly evaluated, the cardiologist can plan the subsequent steps to be taken. Usually, reassurance is all that is required. However, if treatment is needed, modern technology can help to further diagnose and treat most of these medical conditions.
Find out some of the medical procedures available should you need to undergo heart treatment. With the correct insurance coverage, your bill size can be better gauged and managed, while Mount Elizabeth Hospitals can assist with all Medisave, MediShield Life and Integrated Shield Plan claims.