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Q
I have been told I have
a heart murmur. What
does that mean, and
what do I do about it?
Heart murmurs occur when turbu-
lent blood flow is heard through a
stethoscope. Turbulent blood flow
may result from pathologic states
such as leaky or obstructive (stenotic)
heart valves or congenital heart
defects such as holes in the heart
(atrial or ventricular septal defects),
or it may be a normal occurrence
(physiologic flow murmurs). While
not all heart murmurs represent
a significant heart problem that
needs an intervention, the finding
of a heart murmur on physical exam
needs to be investigated.
The first part of any workup for a
heart murmur is a thorough his-
tory and physical examination by a
health care professional. Important
symptoms to look for when see-
ing a patient for a heart murmur
are fatigue, shortness of breath
and chest pain. Other symptoms
include difficulty sleeping flat,
waking up at night short of breath,
leg or ankle swelling, and fainting
or near-fainting spells. During a
physical exam, your doctor will look
for evidence of fluid in your lungs;
leg swelling; and the loudness,
character and location of your heart
murmur. Once your history and
physical is performed, you should
be referred for an echocardiogram.
An echocardiogram is an ultra-
sound of the heart and is completely
noninvasive. It uses sound waves
from a probe placed on the chest
wall to generate pictures of the
heart. These pictures show the
technician and cardiologist reading
the study the function and compe-
tency of the heart valves (there are
four of them), as well as the size
and function of the heart chambers
(also four of them). Using a tech-
nique called color-flow Doppler, the
echocardiographer can examine
blood flow throughout the heart and
across the heart valves, looking for
abnormalities.
Not all heart murmurs require an
intervention and commonly repre-
sent an early finding of an abnormal
heart valve. Patients typically may
have a leaky or narrowed heart
valve for years without ever needing
surgery. The decision to recommend
heart surgery for an abnormal heart
valve involves combining the severity
of the findings on the echocardio-
gram with the nature of the patient’s
symptoms and is usually made in
consultation with a cardiologist and
a cardiothoracic surgeon.
WORRIED ABOUT A
HEART MURMUR?
Dr. Koutlas practices
at Northwest Heart and Lung
Associates in Coeur d’Alene. For
questions or to schedule an
appointment, call
(208) 666-2552
.
Diagnosing a
Heart Murmur
T E D K O U T L A S , M . D . ,
C A R D I O T H O R A C I C S U R G E R Y
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