Heart Murmur

A heart murmur is an extra or unusual sound heard during a heartbeat, usually detected with a stethoscope. Many heart murmurs are harmless, but some can signal an underlying heart valve, structural, or circulation problem that needs medical assessment.

Overview

A heart murmur is an extra sound that a doctor may hear when listening to the heart with a stethoscope. Normal heart sounds are made by heart valves closing as blood moves through the heart. A murmur is usually a whooshing, swishing, or blowing sound caused by blood flow that is faster, more turbulent, or passing through a narrowed or leaking valve.

A heart murmur is not a diagnosis by itself. It is a clinical finding that may be harmless or may point to an underlying heart condition. Innocent, or functional, murmurs can occur when the heart is normal but blood flow is increased, such as during childhood, pregnancy, fever, anemia, or physical activity. These murmurs often do not need treatment.

Abnormal heart murmurs can occur when the heart valves or heart structure do not work in the usual way. Examples include valve narrowing, valve leakage, congenital heart defects, or changes in the heart muscle. Because the sound alone does not always show the cause, a cardiologist may recommend imaging, especially an echocardiogram, to understand the heart’s structure and blood flow.

Symptoms

Many people with a heart murmur have no symptoms at all. The murmur may be found during a routine check-up, a school examination, a pregnancy visit, or an evaluation before surgery. Innocent murmurs usually do not affect daily life and often do not cause tiredness, pain, or breathing problems.

When a murmur is related to an underlying heart problem, symptoms can vary depending on the cause, age, and severity. Some people notice symptoms only during exercise, while others may have symptoms at rest if the heart is under strain. Symptoms may develop slowly over time, which is why regular follow-up can be important.

Symptoms that can be associated with an abnormal heart murmur include:

• Shortness of breath during activity or while lying flat
• Chest discomfort, pressure, or tightness
• Unusual tiredness, reduced exercise capacity, or weakness
• Dizziness, fainting, or near-fainting episodes
• Palpitations or an irregular heartbeat sensation
• Swelling in the ankles, feet, legs, or abdomen
• Bluish lips or fingertips, especially in infants and young children
• Poor feeding, sweating with feeds, or poor weight gain in babies

Causes & Risk Factors

A heart murmur occurs when blood flow through the heart or nearby vessels becomes audible. This can happen in a normal heart when circulation is increased, such as during growth spurts, pregnancy, fever, overactive thyroid, or anemia. These situations can create an innocent murmur because blood is moving more quickly, even though the valves and heart structure may be normal.

Abnormal murmurs are often related to heart valve disease. A valve may be narrowed, making it harder for blood to pass through, or it may leak, allowing blood to flow backward. Valve problems can be present from birth, develop with age, occur after rheumatic fever, or result from infection of the heart lining and valves.

Some murmurs are caused by congenital heart conditions, meaning differences in heart structure that are present at birth. These may include holes between heart chambers, abnormal valve formation, or changes in the major blood vessels connected to the heart. Some congenital conditions are found in infancy, while others are detected later in childhood or adulthood.

Risk factors for an abnormal murmur include a personal or family history of heart valve disease, congenital heart disease, previous heart infection, rheumatic fever, certain connective tissue disorders, high blood pressure, aging-related valve changes, and a history of chest radiation. In pregnancy, a new murmur is often related to increased blood volume, but a doctor may still assess it to rule out significant valve or structural disease.

Diagnosis

Diagnosis begins with a medical history and physical examination. The doctor listens to the murmur’s timing, loudness, location, pitch, and whether it changes with breathing or body position. They also check blood pressure, pulse, oxygen level, signs of fluid retention, and symptoms such as breathlessness, chest pain, fainting, or reduced exercise tolerance.

The most important test for many heart murmurs is an echocardiogram, which is an ultrasound scan of the heart. It shows the heart chambers, valves, pumping function, and direction of blood flow. This helps distinguish an innocent murmur from a murmur caused by valve disease, congenital heart disease, or another structural condition.

Other tests may be used depending on the person’s age, symptoms, and examination findings. These can include an electrocardiogram to assess heart rhythm and electrical activity, a chest X-ray to look at heart size and lung congestion, blood tests to check for anemia, thyroid disease, infection, or other contributors, and exercise testing when symptoms occur with activity.

In selected cases, more detailed imaging may be recommended, such as cardiac MRI, CT imaging, or transesophageal echocardiography, where an ultrasound probe provides closer views of the heart from the esophagus. Cardiac catheterization may be considered if pressure measurements or coronary artery assessment are needed before a procedure. The goal of diagnosis is to identify the cause, severity, and safest monitoring or treatment approach.

Treatment Options

Treatment for a heart murmur depends on its cause. An innocent murmur usually does not require treatment because the heart itself is healthy. In these cases, the doctor may simply explain the finding, recommend routine check-ups, or reassess if symptoms develop. Children with innocent murmurs can often take part in normal activities unless a doctor advises otherwise.

If the murmur is linked to another condition, treatment focuses on that condition. For example, anemia, fever, thyroid disease, or infection may need medical management. When valve disease or congenital heart disease is present, a cardiologist evaluates the severity and decides whether monitoring, medication, a catheter-based procedure, or surgery is appropriate.

Medication may be used to reduce strain on the heart, manage blood pressure, control rhythm problems, reduce fluid buildup, or treat infection when present. Medicines do not repair all valve problems, but they may help control symptoms or protect the heart while a specialist monitors the condition. The correct type of medication, if needed, must be chosen by a qualified doctor after assessment.

Procedural and surgical treatments may be considered for significant valve narrowing, valve leakage, or structural heart defects. Options can include minimally invasive catheter-based repair, valve repair, valve replacement, or closure of certain congenital openings. The right approach depends on the diagnosis, symptoms, imaging results, overall health, and patient preferences, and should be decided by a heart specialist and multidisciplinary team.

Living With / Prognosis

The outlook for a person with a heart murmur depends mainly on the cause. Innocent murmurs have an excellent outlook and may disappear over time, especially in children. They usually do not limit activity, require medication, or mean that the heart is weak. Reassurance from a doctor can help reduce unnecessary worry.

For abnormal murmurs, prognosis varies according to the underlying condition and how early it is identified. Many valve and congenital heart conditions can be monitored safely for years, especially when they are mild and symptoms are absent. Regular follow-up allows doctors to detect changes before they become more serious and to plan treatment at the right time.

People living with a significant murmur may benefit from heart-healthy habits. These include not smoking, maintaining a healthy weight, staying physically active within medical advice, controlling blood pressure and cholesterol, managing diabetes if present, and attending scheduled cardiology appointments. A doctor can also advise whether any precautions are needed before dental or surgical procedures, particularly for people at higher risk of heart valve infection.

Emotional reassurance is also important. Hearing that a murmur is present can be concerning, but the finding is common and often manageable. Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals diagnose and treat heart murmurs and related heart conditions for international patients, using individualized assessment and evidence-based care.

When to See a Doctor

A person should see a doctor if a heart murmur is newly detected, if a known murmur changes, or if symptoms develop. Even when a murmur is likely to be innocent, medical evaluation helps confirm whether the heart structure and valves are normal. This is especially important in babies, children, pregnant people, older adults, and anyone with a history of heart disease.

Prompt medical advice is recommended if a murmur is associated with shortness of breath, chest pain, fainting, dizziness, palpitations, swelling in the legs, or a noticeable drop in exercise capacity. In infants, warning signs include blue lips, poor feeding, sweating during feeds, fast breathing, or poor weight gain. These symptoms do not always mean a serious condition is present, but they should be assessed without delay.

Emergency care is needed for severe chest pain, sudden breathlessness, fainting, confusion, blue discoloration, or signs of stroke such as facial drooping, arm weakness, or speech difficulty. People with fever and a known valve problem, recent heart procedure, or signs of infection should also seek medical care because infection involving the heart valves requires urgent evaluation.

Frequently asked questions

What is a heart murmur?

A heart murmur is an extra sound heard during the heartbeat, usually through a stethoscope. It is caused by blood moving through the heart or nearby blood vessels in a way that creates a whooshing or swishing sound. A murmur can be harmless or may be related to an underlying heart condition.

Is a heart murmur dangerous?

Many heart murmurs are not dangerous, especially innocent murmurs in children and young adults. However, some murmurs are caused by valve disease, congenital heart defects, or other heart conditions. A doctor may recommend tests, such as an echocardiogram, to determine whether the murmur needs monitoring or treatment.

What are the symptoms of a heart murmur?

A heart murmur itself may not cause symptoms and is often found during a routine examination. If it is linked to heart disease, symptoms may include shortness of breath, chest discomfort, fainting, palpitations, fatigue, or swelling in the legs. Babies may show poor feeding, sweating with feeds, fast breathing, or poor weight gain.

How is a heart murmur diagnosed?

A doctor first listens to the heart and assesses the murmur’s timing, loudness, and location. An echocardiogram is commonly used to see the valves, chambers, and blood flow in detail. Other tests, such as an electrocardiogram, chest X-ray, blood tests, or advanced imaging, may be recommended when needed.

Can a heart murmur go away?

Some innocent murmurs can become softer or disappear, especially as children grow. Murmurs caused by temporary conditions such as fever or anemia may improve when the underlying issue is treated. Murmurs due to valve or structural heart disease may persist and need regular follow-up.

What treatment is needed for a heart murmur?

Treatment depends on the cause of the murmur. Innocent murmurs usually need no treatment, while murmurs caused by valve disease or structural heart problems may require monitoring, medication, a catheter-based procedure, or surgery. The best approach should be decided by a cardiologist after a full assessment.

Can someone with a heart murmur exercise?

Many people with innocent murmurs can exercise normally. If the murmur is related to a heart condition, activity recommendations depend on the diagnosis, severity, and symptoms. A doctor or cardiologist should provide personalized advice before starting or intensifying exercise.

References

• American Heart Association
• European Society of Cardiology
• National Heart, Lung, and Blood Institute
• Mayo Clinic
• Cleveland Clinic

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.