Heart Murmur

What is heart murmur?

A heart murmur is an extra or unusual sound that a doctor hears when listening to the heart with a stethoscope. A healthy heartbeat usually makes two sounds, often described as “lub-dub,” which come from the heart valves closing as blood moves through the heart. A murmur is an additional sound — often a whooshing, swishing, or rasping noise — caused by turbulent blood flow inside the heart or through its valves. In medical coding, a heart murmur is classified under ICD-10 code R01.1, which describes a cardiac murmur that has not yet been given a more specific diagnosis.

It is important to understand that a heart murmur is not a disease in itself. It is a physical finding — a sound — that may or may not point to an underlying heart problem. Doctors generally divide murmurs into two broad groups. An innocent murmur (also called a functional or physiologic murmur) occurs in a structurally normal heart and is usually harmless. An abnormal murmur (also called a pathologic murmur) is caused by a structural problem, most often involving one of the heart valves, and may need monitoring or treatment.

Heart murmurs affect people of all ages. Innocent murmurs are extremely common in children — many children have one at some point, especially during periods of rapid growth — and these often disappear on their own. In adults, murmurs may appear temporarily during pregnancy, fever, or anemia, or they may develop gradually with age as heart valves stiffen or leak. Understanding what a heart murmur is, and whether it needs any attention at all, usually requires a careful evaluation by a doctor.

Symptoms

Many people with a heart murmur have no symptoms at all. This is especially true for innocent murmurs, which are often discovered by chance during a routine physical examination or a check-up for another reason. An innocent murmur does not cause symptoms because the heart itself is structurally normal.

When a murmur is caused by an underlying heart condition, symptoms can develop, although they come from the underlying problem rather than from the sound itself. Possible heart murmur symptoms linked to structural heart disease include:

• Shortness of breath, especially during physical activity or when lying flat
• Chest pain, pressure, or discomfort
• Fatigue or reduced ability to exercise
• Dizziness or lightheadedness
• Fainting (syncope), particularly during exertion
• Palpitations — a sensation of a racing, pounding, or irregular heartbeat
• Swelling (edema) in the legs, ankles, or abdomen
• Bluish tint to the skin or lips (cyanosis), which is more often seen in infants with congenital heart problems
• In babies: poor feeding, sweating during feeds, and slow weight gain

Symptoms often differ depending on the type and severity of the underlying condition. In the early stages of a valve problem, there may be no symptoms for many years, because the heart can compensate for a mildly narrowed or leaky valve. As the condition progresses, symptoms such as breathlessness, fatigue, and swelling may appear gradually. In children with congenital heart defects — structural problems present from birth — signs may be noticeable in infancy, such as feeding difficulties, poor growth, or bluish skin. In contrast, murmurs related to temporary conditions, such as fever, anemia (a low red blood cell count), or an overactive thyroid gland, usually resolve when the underlying condition is treated.

Because symptoms overlap with many other conditions, no symptom on its own confirms or rules out a significant heart problem. That is why a proper heart murmur diagnosis relies on medical evaluation rather than symptoms alone.

Causes and risk factors

Heart murmur causes fall into two main categories: those that occur in a normal heart, and those that reflect a structural heart problem.

Causes of innocent murmurs

Innocent murmurs happen when blood flows through a normal heart more quickly or forcefully than usual. Common situations include:

• Childhood growth — rapid growth phases in children often produce temporary murmurs
• Fever or infection, which speed up blood flow
• Pregnancy, because the amount of blood circulating in the body increases
• Anemia, a shortage of red blood cells, which changes how blood flows
• Hyperthyroidism, an overactive thyroid gland that raises the heart rate
• Vigorous exercise or strong emotion

Causes of abnormal murmurs

Abnormal murmurs are usually related to a structural problem in the heart, most often affecting the valves — the flap-like structures that keep blood moving in one direction. Common causes include:

• Valve stenosis — narrowing of a valve, which forces blood through a smaller opening (for example, aortic stenosis)
• Valve regurgitation — a leaky valve that allows blood to flow backward (for example, mitral regurgitation)
• Mitral valve prolapse — a valve that bulges backward as the heart contracts, sometimes allowing leakage
• Congenital heart defects — structural problems present from birth, such as holes between heart chambers (septal defects) or abnormally formed valves
• Endocarditis — an infection of the inner lining of the heart or its valves, which can damage valve tissue
• Rheumatic heart disease — valve damage that can follow untreated strep throat infections, now less common where antibiotics are widely used
• Age-related valve changes, including calcium buildup that stiffens valves over time

Risk factors

Certain factors make an abnormal heart murmur more likely, including:

• A family history of congenital heart defects or valve disease
• Older age, because valves can degenerate over time
• A history of rheumatic fever or untreated strep infections
• Previous heart infections such as endocarditis
• Certain medical conditions, including high blood pressure and some autoimmune diseases
• In infants, certain conditions during pregnancy — for example, poorly controlled maternal diabetes or some infections during pregnancy — are associated with a higher chance of congenital heart problems

Diagnosis

Heart murmur diagnosis begins with a careful physical examination. Using a stethoscope, the doctor listens to the heart at several points on the chest and pays attention to specific features of the murmur, including:

• Timing — whether the sound occurs while the heart is contracting (systolic), relaxing (diastolic), or throughout the heartbeat (continuous)
• Loudness — murmurs are commonly graded on a scale from 1 (very faint) to 6 (very loud)
• Location and radiation — where on the chest the murmur is loudest and whether it can be heard elsewhere, such as the neck or back
• Pitch and quality — for example, harsh, blowing, or musical
• Changes with position or breathing — some murmurs change when the patient stands, squats, or breathes in a certain way, which gives clues about the cause

Many innocent murmurs can be recognized by an experienced doctor based on the examination alone, particularly in healthy children with no other findings. When the features of the murmur suggest a possible structural problem, or when the picture is unclear, further tests are usually ordered:

• Echocardiogram (heart ultrasound) — this is the key test for evaluating a murmur. It uses sound waves to create moving images of the heart, showing the valves, chambers, and blood flow in real time. It can identify narrowed or leaky valves, holes in the heart, and other structural problems, and can estimate how severe they are.
• Electrocardiogram (ECG or EKG) — a recording of the heart’s electrical activity, which can show rhythm problems or signs that the heart is under strain.
• Chest X-ray — an image that can show the size and shape of the heart and whether fluid has built up in the lungs.
• Cardiac MRI or CT scan — detailed imaging that may be used in selected cases when the echocardiogram does not give enough information.
• Cardiac catheterization — a procedure in which a thin tube is guided into the heart through a blood vessel. It is reserved for specific situations, such as measuring pressures inside the heart before certain treatments.
• Blood tests — these may be used to look for contributing conditions such as anemia, thyroid problems, or infection.

The goal of this evaluation is to answer two questions: is the murmur innocent or abnormal, and if it is abnormal, what is causing it and how severe is it? The answers guide everything that follows.

Treatment options

Heart murmur treatment depends entirely on the cause. Because a murmur is a sound rather than a disease, doctors do not treat the murmur itself — they treat the underlying condition, if one exists. Conditions involving heart murmurs are typically managed by cardiologists, such as those in a Cardiology Department, sometimes together with cardiac surgeons when a structural repair is needed.

No treatment or watchful waiting

Innocent murmurs require no treatment at all. Children with innocent murmurs can usually live, play, and exercise without any restrictions, and many of these murmurs fade or disappear as the child grows. When a murmur is caused by a temporary condition such as fever, anemia, or pregnancy, it often resolves once that condition passes or is treated.

For mild valve problems that are not causing symptoms, doctors often recommend watchful waiting: regular check-ups and periodic echocardiograms to monitor whether the condition changes over time. Many people with mild valve disease remain stable for years and never need a procedure.

Medications

Medications do not fix a damaged valve, but they can manage symptoms, treat related conditions, and reduce strain on the heart. Depending on the situation, a doctor may prescribe:

• Diuretics (“water pills”) to reduce fluid buildup and ease breathlessness or swelling
• Blood pressure medications, such as ACE inhibitors or beta-blockers, to lower the workload on the heart
• Anticoagulants (blood thinners) to reduce the risk of blood clots in certain valve conditions or rhythm problems such as atrial fibrillation
• Medications to control heart rhythm when an irregular heartbeat accompanies valve disease
• Antibiotics to treat endocarditis; in selected high-risk patients, antibiotics may also be recommended before certain dental or surgical procedures to help prevent valve infection — current guidelines limit this to specific situations, so it is decided case by case

Procedures and surgery

When a valve problem or congenital defect is severe, or begins to cause significant symptoms or heart strain, a procedure may be recommended. Options vary by condition and may include:

• Balloon valvuloplasty — a catheter-based procedure in which a small balloon is inflated inside a narrowed valve to widen it, used for certain types of stenosis
• Valve repair — surgery that preserves the patient’s own valve while fixing the leak or narrowing; often preferred when technically possible
• Valve replacement — replacing a damaged valve with a mechanical valve or a biological (tissue) valve, either through open surgery or, in suitable patients, through catheter-based techniques such as TAVI/TAVR (transcatheter aortic valve implantation)
• Repair of congenital defects — closing holes in the heart or correcting other structural problems, either surgically or with catheter-delivered devices, depending on the defect

The choice among these options depends on the specific valve or defect involved, its severity, the patient’s age and overall health, and individual anatomy. Your care team will explain the benefits and risks that apply to your situation; there is no single approach that suits everyone.

Living with heart murmur / outlook

The outlook for someone with a heart murmur depends almost entirely on the cause. People with innocent murmurs have a normal heart, a normal life expectancy, and no need for restrictions or ongoing treatment. For many children, the murmur simply disappears over time.

For people with an underlying valve condition or congenital defect, the outlook varies widely. Mild valve disease often remains stable for many years and may never require intervention, provided it is monitored. More significant valve problems can usually be treated effectively with modern procedures, and many people return to full, active lives afterward, although lifelong follow-up with a cardiologist is generally advised. At institutions such as Acibadem, this long-term follow-up is typically coordinated through the cardiology service, with regular echocardiograms to track how the heart and valves are functioning over time.

Practical steps that support heart health in general — and that doctors often recommend for people with valve conditions — include:

• Attending all scheduled follow-up appointments and imaging tests
• Taking prescribed medications consistently and reporting side effects
• Maintaining good dental hygiene, since gum and dental infections can, in some cases, allow bacteria to reach the heart valves
• Managing blood pressure, cholesterol, and blood sugar
• Not smoking, eating a balanced diet, and staying physically active within the limits your doctor advises
• Telling all healthcare providers, including dentists, about your heart condition before procedures

No one can guarantee how any individual condition will progress, which is why regular monitoring matters: it allows changes to be detected and addressed before they cause serious harm.

Frequently asked questions

What is a heart murmur, in simple terms?

A heart murmur is an extra sound — often a whooshing or swishing noise — that a doctor hears between the normal heartbeat sounds when listening with a stethoscope. It is caused by turbulent blood flow in the heart. It is a finding, not a disease: some murmurs occur in perfectly healthy hearts, while others point to a valve problem or another structural condition that needs evaluation.

Is a heart murmur serious?

Often it is not. Many murmurs, especially in children, are innocent murmurs that occur in a normal heart and cause no harm. However, some murmurs are caused by valve disease, congenital defects, or infection, which can be serious if left untreated. Only a medical evaluation — usually including an echocardiogram when there is any doubt — can determine which type a person has, so a newly discovered murmur should always be assessed by a doctor.

Can a heart murmur go away on its own?

Yes, in many cases. Innocent murmurs in children frequently fade or disappear as the child grows. Murmurs caused by temporary conditions such as fever, anemia, or pregnancy often resolve once the underlying situation passes. Murmurs caused by structural valve damage, on the other hand, generally do not go away on their own and may need monitoring or treatment over time.

What are the most common heart murmur symptoms?

Many murmurs cause no symptoms at all. When a murmur is linked to an underlying heart condition, possible symptoms include shortness of breath, chest discomfort, fatigue, dizziness, fainting, palpitations, and swelling in the legs or ankles. In infants, poor feeding, sweating during feeds, slow weight gain, or a bluish tint to the skin can be signs of a congenital heart problem. Because these symptoms have many possible causes, they should be evaluated by a doctor rather than assumed to come from the murmur.

How do doctors diagnose a heart murmur?

Diagnosis starts with a physical examination, during which the doctor listens carefully to the murmur’s timing, loudness, location, and quality. If the features suggest an underlying problem, or if the cause is unclear, the main follow-up test is an echocardiogram — an ultrasound of the heart that shows the valves and blood flow. An electrocardiogram, chest X-ray, blood tests, and in selected cases cardiac MRI, CT, or catheterization may also be used.

Does every heart murmur need treatment?

No. Innocent murmurs need no treatment, and mild valve conditions are often simply monitored with regular check-ups. Treatment — which may include medications, catheter-based procedures, or surgery — is reserved for cases where an underlying condition is causing symptoms, straining the heart, or is severe enough that intervention is expected to help. The decision is individualized and made together with a cardiologist.

Can I exercise if I have a heart murmur?

Most people with innocent murmurs can exercise without any restrictions. For people with an underlying valve condition or congenital defect, the answer depends on the specific diagnosis and its severity: many can stay active with few or no limits, while some conditions call for avoiding certain intense activities. Because this varies so much, it is important to ask your own doctor what level of activity is appropriate for you before starting or changing an exercise program.

When to see a doctor

Any newly noticed heart murmur should be evaluated by a doctor, even if you feel well, so that its cause can be identified. If you have already been told you have a murmur, keep your scheduled follow-up visits, and contact your doctor sooner if your symptoms change or worsen.

Seek urgent medical attention — including emergency care where appropriate — if you or your child experiences any of the following red-flag warning signs:

• Chest pain or pressure, especially if it occurs with exertion or does not go away
• Severe or sudden shortness of breath, or difficulty breathing while lying flat
• Fainting or near-fainting, particularly during physical activity
• A rapid, pounding, or irregular heartbeat that does not settle
• Bluish color of the lips, skin, or fingernails
• New or rapidly worsening swelling in the legs, ankles, or abdomen
• Unexplained fever in someone with known valve disease or an artificial heart valve, since this can be a sign of a heart valve infection
• In infants: poor feeding, sweating or breathlessness during feeds, unusual drowsiness, or failure to gain weight

These signs do not always mean there is a serious heart problem, but they warrant prompt evaluation. Acting early gives doctors the best chance to identify the cause and, if needed, treat it before complications develop.