Understanding heart murmurs

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' By strict definition, a heart murmur is simply a slightly different heart sound, picked up as blood flows through your heart. "Most of the time murmurs indicate no special problem; they usually don t mean your heart is diseased or damaged," says Stephen Devries, M.D., a preventive cardiologist at Northwestern Memorial Hospital in Chicago, Ill. "All murmurs aren t created equal," says Jerome E. Granato, M.D., director of the coronary care unit at Allegheny General Hospital in Pittsburgh, Pa. "Some make mild noise and usually are innocent. Others are louder and may represent something more significant." Heart valves The heart contains four valves, including the aortic and mitral. They function in a coordinated manner to make sure the blood flows properly in and out of the heart. Normally a valve opens to let blood through, then closes to keep it from leaking backward. When a valve thickens and impairs blood flow, it s called a stenosis. When it doesn t close properly and there s a leak, it s called an insufficiency. In either case, the changes in blood flow can cause a murmur. "Aging brings wear and tear that can cause minor valve problems," Devries says. "Almost everyone in their 70s and 80s has some valve thickening, so murmurs can develop over time. Most of the time it isn t something to worry about." Wear and tear is why older adults need to be aware of the potential dangers of heart murmurs. "Someone could be born with a misshaped heart valve, and for years it just makes a little noise without causing any problems," says Granato. "But it s like having your car s wheels out of alignment the car can run, but the wheels become worn prematurely. The same can be true of a heart with a murmur." "Someone in their 60s with a murmur may initially have no problems, but it needs to be evaluated periodically," says Dimitri Cefalu, M.D. "The valve abnormality could lead to other complications. People might complain of dizziness or experience episodes of fainting. Either of these may indicate that the valve needs replacement." "Many people as they age have trouble breathing or fatigue more easily. If they ve never had a heart murmur, it might be something to look for," Devries says. "If they ve always had a murmur, breathing problems could be a sign that the valve problem is becoming worse." One danger that can occur at any age is bacterial infection, which can do significant damage to the valve. "Heart infections can lead to an inflammation called endocarditis (EN-dough-car-DYE-tis), which could destroy or further deform the valve. Then it might need replacement," Cefalu says. Some doctors prescribe antibiotics after surgery for people with heart murmurs, who may be more susceptible to this infection. Pinpointing problems "Before we had sophisticated monitoring equipment, a good general practitioner or cardiologist could pick up a murmur just with a stethoscope," Cefalu says. "That s still true, but now we also have EKGs and an ultrasound machine called an echocardiogram. The latter gives us nice views of the valves, so we can truly see what s going on." That s especially important to help doctors differentiate heart murmur from other problems an older adult might be having. "If you re fatigued, is it because you ve developed sleep apnea and aren t sleeping properly? Is your shortness of breath from a lung problem, like COPD? Or are these valve problems?" Granato asks. "The nice thing about the ultrasound is it can help answer these questions in a way that s noninvasive no needles or poking. It s a great way to get an accurate picture," Devries adds. Providing treatment Except for the bacterial infections that need antibiotics, many heart murmurs don t require immediate treatment. Instead, regular checkups, by either your primary doctor or a cardiologist, are all that s needed. "When medicine is given, it could be something common like a regular blood pressure medication," Cefalu says. Or it could be a diuretic to fight the leakage. "That isn t very efficient. It s like having a leaking sink and you mop up the water in your cabinet. That s not stopping the actual problem," Granato says. Medication may be best for someone older and ill who might not withstand surgery. Ask your primary care doctor for a referral to a cardiac surgeon to discuss your options.

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A web site that is dedicated to heart sounds is www.easyauscultation.com

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