Ask the Doctors by Eve Glazier, M.D. and Elizabeth Ko, M.D

Different Kinds of Heart Murmurs Require Different Treatments

Dear Doctor: My 7-year-old niece has been diagnosed with a heart murmur, and my brother says she won’t be receiving any kind of treatment. What is a heart murmur? Will it interfere with the activities she loves, like soccer and softball?

Dear Reader: When someone has a heart murmur, it means an extra and unusual sound has been detected while their heart beats.

During the normal cycle of a heartbeat, blood is propelled through the chambers of the heart via muscle contractions, and its flow is directed by a series of valves that open and close in a specific sequence and pattern. The normal two-part sound of a heartbeat, which is often described as lub-DUB, is made by the heart valves as they close. When someone has a heart murmur, their heartbeat makes a whooshing or swishing sound. This is caused by turbulent blood either within or near the heart. We know that all of this can sound alarming, but a heart murmur isn’t necessarily dangerous and doesn’t automatically require treatment. A heart murmur may be congenital, which means you are born with it, or it can develop later in life.

The condition is divided into two categories -- innocent or abnormal. Innocent heart murmurs, sometimes also referred to as functional or normal murmurs, don’t pose a danger to the individual and generally don’t require treatment. An innocent heart murmur is a common finding in children and infants. In the majority of cases, no structural abnormalities to either the heart or the vessels that serve it are present. In fact, researchers estimate that fewer than 1% of childhood heart murmurs are associated with congenital heart disease.

An abnormal heart murmur can be caused by structural problems that interfere with optimal cardiac function. These can include valve abnormalities or septal defects, which are holes in the heart. Infections, such as rheumatic fever, can lead to a heart murmur. So can endocarditis, which is an infection of the heart’s inner lining.

In some people, an abnormal heart murmur is accompanied by symptoms such as shortness of breath, a bluish tinge to the skin or lips, chest pain, rapid breathing, a chronic cough or light-headedness. Abnormal heart murmurs require treatment, which can range from medications to manage the condition, to surgery to repair the structural causes.

The fact that your niece has seen a doctor and won’t receive treatment suggests she has an innocent murmur. However, her doctor will continue to monitor the murmur throughout her childhood. If problems arise, she will be referred to a pediatric cardiologist, who may use an X-ray, electrocardiogram or echocardiogram to learn more about her heart and the murmur.

For the majority of children living with an innocent heart murmur, life goes on as normal. They can run, ride bikes, jump rope, go swimming and play sports. If she begins to exhibit any of the symptoms we mentioned earlier, then she will need to be reevaluated. But the good news is that in many cases, innocent heart murmurs resolve by themselves by adulthood.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)