A heart murmur may be diagnosed as benign — harmless — or it may need more attention. Just ask Summer Ash, now 38, an astrophysicist who is the director of outreach for Columbia University’s Department of Astronomy in New York City. During a routine physical exam when she was in college, her physician heard a heart murmur and referred Ash for an echocardiogram. The test results indicated that her murmur was nothing to worry about. Years passed, and Ash ignored her urge to follow up — until her mother was hospitalized for a reaction to a cold medication that affected her heart rate. That was all the motivation Ash needed. She asked her mother’s cardiologist to review her echocardiogram report, and the cardiologist ordered a new echocardiogram. To her shock, Ash found out she had an extremely rare congenital condition called a bicuspid aortic valve. This is a defect that just 1 percent of people are born with, according to the U.S. National Library of Medicine. The malfunctioning valve exerts extra pressure on the heart’s aorta. In Ash’s case, the pressure caused the artery wall to stretch and balloon, creating an aortic aneurysm. These life-threatening weak spots on an artery’s wall can rupture, causing internal bleeding that can be fatal. Ash’s open-heart surgery two years ago to repair her aortic valve was successful. But after surgery, her heartbeat became louder, even audible, and the pounding was so strong that it became a constant reminder of her surgery. (You can hear audio of her heartbeat on RadioLab where Summer shared her story.) Now she’s dealing with post-traumatic stress disorder (PTSD) — the emotional fallout from having a near-death experience coupled with such traumatic surgery, she says. One way she furthers her healing process is through writing and sharing her experience on her online blog.
Where Your Heartbeat Comes From
A quick review of the heart’s anatomy reveals where its various sounds come from. This four-chambered muscle contains two upper chambers, called the atria, and two lower chambers, called the ventricles. Between each chamber, four little valves open and close with every heartbeat to keep the blood flowing in the right direction, notes the Texas Heart Institute. These are called the aortic, pulmonary, tricuspid, and mitral valves. The sounds — normal and abnormal — that your heart makes come from:
Vibrations when the valves open and closeBlood that flows too fast or abnormally through the chambersTension in the tissues that connect the heart valves to heart muscle
“Listening to heart sounds through a stethoscope, along with a patient’s medical history and other clinical data, can help us diagnose a variety of heart conditions,” says Seth Martin, MD, assistant professor of cardiology at Johns Hopkins School of Medicine in Baltimore. Heart murmurs, for example, are common heart sounds that sometimes indicate heart-valve disease, according to the National Heart, Lung, and Blood Institute. Other heart sounds can help diagnose less common conditions. The “friction rub” sound, for example, can help diagnose pericarditis, which is an inflammation of the pericardium, the heart’s sac-like covering. A “gallop,” which actually mimics the sound a horse makes when running, could indicate a type of heart failure in those over 40, says Dr. Martin.
What Makes Your Heart Murmur
Heart valve problems usually cause heart murmurs, notes the American Heart Association. Murmurs can occur when a valve doesn’t close properly, allowing blood to leak backwards, a condition called “regurgitation.” A murmur may also arise when blood flows through a valve that’s narrowed or stiffened by disease, a condition known as stenosis. “Different heart murmurs make different sounds,” says Martin. While many murmurs are benign, others can point to problems. “We can gauge whether a murmur needs immediate attention or further exploration by listening to certain features of the sound,” he explains. The murmur’s loudness can be helpful — or misleading. Someone with a loud murmur might not have serious disease, while someone with a softer murmur could. “So we pay attention to other factors as well,” says Martin. “The timing of the peak of the murmur, along with any symptoms and other clues from the physical examination, are crucial in deciding how significant a heart murmur is, and if it’s benign or needs more attention.”
Noisy Heart Problems
In addition to heart murmurs, your doctor may also be able to detect sounds that indicate congenital heart disease and sometimes disease of the heart muscle itself. These problems can make sounds that a physician can hear if he or she has been properly trained, says Theo E. Meyer, MD, PhD, director of the Advanced Heart Failure Program and Professor of Medicine at the University of Massachusetts School of Medicine in Worcester. RELATED: 10 Things Your Doctor Won’t Tell You About Congenital Heart Defects However, due to the advent of sophisticated imaging tests such as echocardiograms, CT scans, MRIs, and PET scans, most doctors no longer get comprehensive training in auscultation, which is the art of listening to and interpreting the sounds the body makes. “This kind of training is a dying art form these days,” says Dr. Meyer. Most people can’t hear the sound of their own hearts beating, unless they’ve had certain kinds of valve surgery, as in Ash’s unusual case. “People who’ve had heart surgery years ago may have older style mechanical heart valves,” explains Dr. Meyer. “These may make clicking sounds that you can easily hear. Newer valves are quieter,” he says.
Children Can Have Noisy — but Healthy — Hearts
If your child’s pediatrician mentions that your son or daughter has a heart murmur, it’s not necessarily cause for alarm, says W. Reid Thompson, MD, associate professor of pediatric cardiology, at Johns Hopkins Children’s Center in Baltimore. Children are more likely to have heart murmurs than adults,” says Dr. Thompson. “In fact, up to 70 percent of children will have an occasional heart murmur, and the vast majority of them are innocent — meaning they’re caused by blood flowing through a healthy heart. However, listening to a child’s heart can be complicated because little children rarely sit quietly and stay still during a physical exam. That makes listening for subtle abnormalities a bit of a challenge, says Thompson. “Despite all the new technology we have, simply listening to the heart still gives us some quick, powerful information that can be crucial in letting us know who needs special imaging studies, when conditions have improved or worsened, and when things are probably fine,” says Thompson. “I still use my stethoscope almost every day, even though my other specialty is echocardiography [ultrasound imaging] of the heart. We’re still learning how to use technology to improve our listening skills and how to teach this still-relevant skill to new doctors in training,” he says.
