Heart Murmurs: Innocent Heart Murmur v/s Abnormal Heart Murmur

A heart murmur is an unusual sound heard during the heartbeat. Innocent heart murmurs need no treatment, because the heart’s structure is normal. Abnormal murmurs, on the other hand, are caused by an underlying heart problem or a defect a person is born with. If a person also has symptoms like breathlessness, chest pain, or fainting, they should see a doctor. In infants, signs to watch for include poor feeding, blue lips, and low weight.

A healthy heart makes a regular “lub-dub” sound. If you hear a whooshing, humming, or swishing sound in between, that is a heart murmur. It happens when blood moves through the heart with more force than usual.

A heart murmur is not a disease. It is just a sound, and most of the time it is harmless and needs no treatment. Still, it shouldn’t be ignored completely, as sometimes it points to a problem in the heart.

A trained specialist looks at your symptoms along with the murmur’s loudness, location, pitch, and other details to decide whether it is innocent or abnormal.
If you or someone you know has a heart murmur, book a consultation with our specialist at Artemis Cardiac Care for proper diagnosis and treatment.

What Is an Innocent Heart Murmur?

An innocent heart murmur, as the name suggests, is completely harmless. The sound just means that your blood is flowing quickly through the heart. It is also called a functional murmur or physiological murmur. These are not persistent. They come and go and require no treatment.

Innocent heart murmurs are common in children and young adults. A study on the evaluation and management of heart murmurs in children suggests that nearly 8.6% of infants and 80% of children develop a heart murmur during the early years of their life. Another study on the evaluation of heart murmurs in children points out that heart murmurs are the most common reason why parents need to take their children to a pediatric cardiologist.

What Causes Innocent Heart Murmurs?

If a child is not feeling well or has a fever, these may become more noticeable. The same happens after physical activity or a growth spurt. This is because all these factors can speed up their heartbeat. This increases the flow of blood, and hence the sounds are more prominent.

Features of Innocent Heart Murmurs

Doctors use the 7S rule to find out whether the heart murmur is innocent or not.

Innocent heart murmurs are:

Systolic, which means that these only occur during the contraction phase of the heart, also known as systole.
Small, which means that these are heard only in a specific part of the heart and are confined to that area only. These do not radiate.
Soft, which means that these are not too loud and usually graded as 1 to 3 on an intensity scale that goes up to 6.
Short in duration, which means that these are brief sounds. They may come and go, but are not persistent.
Singular, which means that there is no other abnormal sound, like clicks or snaps.
Sweet, which means that the sounds are not rough or harsh. In fact, these are distinctively musical.
Sensitive to positioning, which means that these change significantly when you change your body’s position. It becomes extremely soft or may even disappear while the patient is standing.

In most cases, innocent murmurs do not require any treatment, medication, or restriction in day-to-day activities. In children, these keep on becoming milder and milder as they grow.

What Is an Abnormal Heart Murmur?

An abnormal heart murmur is an unusual whooshing sound that your heart makes when the blood is rushing through it. It is caused by an underlying disease or condition of the heart that may be present since birth or developed later. Abnormal heart murmur is also known as a pathologic murmur.

Abnormal heart murmurs do not go away on their own and require proper assessment and treatment of the underlying condition. In adults, it is usually caused by problems related to the heart valve such as buildup of calcium in the valves, whereas in children, these could be an indication of a congenital heart defect, such as a hole in the heart.

What Causes Abnormal Heart Murmur?

Heart valve disease: A heart murmur could be caused by an underlying heart valve disease, such as valve stenosis or valve regurgitation. Valve stenosis means that there is an obstruction in the flow of blood through the heart valve, whereas regurgitation means that the valve is not able to close properly, leading to the backward flow of blood. Both the conditions can lay additional strain on the heart because of which blood has to forcefully move through it.
Congenital heart defects: A heart murmur in children is often linked to developmental defects in the heart. This is present since birth. The most common causes are a hole in the heart chambers or an abnormality in the heart valve.
Infective endocarditis: A heart murmur may also be caused by a bacterial infection that spreads through the heart via the bloodstream. The bacteria enter the body through the mouth and go into the bloodstream, from where they travel towards the heart. If not treated promptly, this can lead to serious complications and damage the heart valves.
Rheumatic heart disease: This develops in people with rheumatic fever. The disease triggers an abnormal immune response. As a result, the immune system of the person starts attacking healthy cells and tissues of the heart. This can cause permanent damage and scarring. All this can affect the normal function of the heart and disrupt normal blood flow.
Cardiomyopathy: Cardiomyopathy disease affects the muscles of the heart and causes structural and functional changes. These changes prevent the heart from pumping blood efficiently. It can cause the thickening of the septum, affecting the flow of blood from the left ventricle. It also affects mitral valve function, leading to regurgitation.

Abnormal Heart Murmur Symptoms You Should Not Ignore

If a person is seeing any of the following symptoms with a heart murmur, it is important to see a doctor immediately.

Breathlessness during activity or while lying flat.
Chest pain or pressure.
Dizziness, light-headedness, or fainting.
Unusual tiredness or reduced exercise tolerance.
Palpitations or a racing heartbeat.
Swelling of the feet, ankles, or abdomen.
Blue or gray discoloration of the lips, tongue, or fingertips.
Persistent cough, especially at night.

In infants, babies, and young children, the warning signs include excessive sweating even while feeding, poor feeding, fast breathing, poor weight gain, and lethargy.

Innocent Heart Murmur v/s Abnormal Heart Murmur

Feature	Innocent heart murmur	Abnormal heart murmur
What it means	Heart is structurally normal; blood simply flows faster than usual	A problem with the heart causes the sound
Symptoms	Usually none	May have symptoms, depending on the cause
Who gets it	Common in babies, young people, and adults	Less common, especially in babies and young people
Behavior	Can come and go	Usually persists
Treatment	Not needed	Depends on the underlying cause

How Is a Heart Murmur Diagnosed?

A heart murmur is usually diagnosed using an echocardiogram. Other tests that may be recommended include an electrocardiogram (or ECG), a chest X-ray, and blood tests.

Echocardiogram helps doctors to see various structures of the heart and analyze the flow of blood through them.
Electrocardiogram helps with checking the electrical activity of the heart.
Chest X-ray may be recommended to find any structural abnormality.
Blood tests help to find out if the murmurs are caused by conditions like anemia, thyroid, or inflammation.

How Is A Heart Murmur Treated?

An innocent heart murmur does not usually require any treatment or medication. An abnormal heart murmur can be treated by addressing the condition that causes it. The treatment varies from one person to another depending on the underlying condition. In some cases, it can be controlled with the help of medication alone, while others may require surgery.

Conclusion

A heart murmur is an abnormal sound produced by the heart, and it can be due to many reasons. Innocent heart murmurs are those that are not caused by a serious condition, and these do not necessarily require treatment, whereas abnormal heart murmurs are those which are caused by a serious heart disease or defect. In such cases, proper treatment and monitoring are important. A trained specialist can help you understand whether your heart murmur is innocent or abnormal. Based on this, your treatment will be recommended. Book an appointment with an expert Cardiologist in Bikaner at Artemis Cardiac Care for advanced heart murmur treatment.

FAQs

Q1: Are all heart murmurs dangerous?
A: No, not all heart murmurs are dangerous. Even people with a completely healthy heart can experience these. Such heart murmurs are commonly known as innocent heart murmurs. The ones that require treatment and could prove to be dangerous are abnormal heart murmurs.

Q2: Can an innocent heart murmur go away?
A: Yes, an innocent heart murmur can go away as a child grows. These tend to become milder and milder. In some cases, they may also continue throughout life without causing any problem. Whether you require any treatment or not is decided by your doctor based on how it is interfering with your daily life.

Q3: What are the warning signs of an abnormal heart murmur?
A: Warning signs of an abnormal heart murmur are difficulty in breathing, pain in the chest, losing consciousness, feeling lightheaded, palpitations, swelling in the limbs, and abdominal bloating. In small babies, there may also be a bluish color on the lips and fingertips, poor feeding, sweating, fast breathing, and poor weight gain.

Q4: How is a heart murmur confirmed?
A: To confirm a heart murmur, doctors first use a stethoscope to listen to the heartbeat carefully. This is followed by an echocardiogram to confirm the diagnosis. Doctors may also advise ECG, chest X-ray, and blood tests. These help to find the cause of a murmur.

Q5: Can a child with a heart murmur play sports?
A: Whether a child with a heart murmur can play sports or not can only be suggested by a doctor. This is because it depends on the cause of the murmur. In most cases, there are no restrictions on sports and physical activities.

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