Should You Be Concerned About Heart Murmur and Palpitations?

Key Takeaways

Most heart murmurs are innocent and harmless, but all should be evaluated by a doctor to check for underlying heart disease
Symptoms like shortness of breath, chest pain, or extreme fatigue with heart murmurs may indicate serious valve problems requiring treatment
Regular monitoring and lifestyle changes can help manage heart murmurs and palpitations effectively when underlying conditions are present

Understanding Heart Murmurs and Palpitations

Heart murmurs are extra sounds your heart makes beyond the normal lub-dub rhythm, while palpitations are when you actually feel your heart beating differently. Both happen when blood flows through your heart in ways that create noise or unusual sensations.

What Is a Heart Murmur?

A heart murmur is a whooshing or swishing sound that doctors hear with a stethoscope. It happens when blood flows through your heart in a way that creates extra noise.

Your normal heartbeat makes a “lub-dub” sound. The first sound happens when valves close as your heart squeezes blood out.

The second sound occurs when different valves close as your heart fills back up. Two main types exist:

Innocent murmurs – These are harmless and don’t mean anything is wrong
Abnormal murmurs – These may signal a heart problem that needs attention

Most heart murmurs are innocent, especially in children. Many people have them without ever knowing it.

Doctors can usually tell the difference between harmless and concerning murmurs just by listening. Innocent murmurs often sound soft and gentle.

Abnormal murmurs may sound louder or harsher. The timing and location of the sound also help doctors decide if more tests are needed.

What Are Palpitations?

Palpitations are when you can feel your heart beating in your chest. Your heart might feel like it’s racing, fluttering, or skipping beats.

Most people don’t normally feel their heartbeat during daily activities. When you do notice it, that’s a palpitation.

They can happen in your chest, throat, or neck. Common descriptions include:

Heart racing or pounding
Fluttering like a butterfly
Skipping or missing beats
Beating too hard

Palpitations can last a few seconds or several minutes. They might happen once in a while or more often.

Many things can cause them, from stress and caffeine to heart problems. Not everyone with a heart murmur gets palpitations.

Many people who feel palpitations don’t have heart murmurs. These are two separate things that can happen together or apart.

How Turbulent Blood Flow Creates Heart Murmurs

Turbulent blood flow is the main cause of heart murmurs. When blood moves smoothly through your heart, it makes the normal lub-dub sounds.

When blood hits obstacles or moves through tight spaces, it creates turbulence. Think of water flowing through a garden hose.

Smooth water flow is quiet. But if you squeeze the hose or create a kink, the water makes noise as it pushes through.

Common causes of turbulent flow:

Narrow or stiff heart valves
Leaky valves that let blood flow backward
Holes in heart walls
Fast blood flow during exercise or fever

The turbulence creates vibrations that we hear as whooshing or swishing sounds. Louder turbulence usually means more severe problems, but not always.

Even normal hearts can create turbulent flow sometimes. This happens when blood moves faster than usual, like during exercise or when you have a fever.

These temporary murmurs usually go away when your heart rate returns to normal.

Types of Heart Murmurs

Heart murmurs fall into two main categories based on whether they indicate a heart problem. We also classify them by when they occur during the heartbeat cycle.

Innocent Versus Pathological Murmurs

Innocent heart murmurs are harmless sounds that don’t signal any heart problems. We also call these benign murmurs.

These murmurs are common in newborns and children. They occur when blood flows normally through a healthy heart.

What causes innocent murmurs:

Fever
Physical activity
Pregnancy
Anemia
Overactive thyroid

Most innocent murmurs disappear as children grow older. Adults can have them too, but they’re less common.

Pathological murmurs point to actual heart problems. These abnormal sounds happen when something affects normal blood flow through the heart.

Common causes include:

Heart valve problems
Holes in the heart
Narrowed or leaky valves
Heart muscle weakness

Pathological murmurs need medical attention. We use tests like echocardiograms to find the underlying cause.

Systolic, Diastolic, and Continuous Murmurs

We classify murmurs by when they happen during your heartbeat. Systolic murmurs occur when the heart muscle contracts and pumps blood out.

These are the most common type of murmur. Most systolic murmurs in children are innocent.

In adults, they may indicate valve problems like narrowing or leaking. Diastolic murmurs happen when the heart relaxes and fills with blood.

These murmurs are almost always pathological. Diastolic murmurs often mean the heart valves aren’t closing properly.

This allows blood to flow backward. Continuous murmurs occur throughout the entire heartbeat cycle.

They happen during both contraction and relaxation phases. A continuous murmur usually indicates abnormal blood flow between arteries and veins.

This type always needs medical evaluation.

Symptoms and Warning Signs

Most heart murmurs don’t cause symptoms and are found during routine checkups. However, certain symptoms can signal when a murmur needs medical attention, ranging from mild fatigue to serious warning signs like chest pain.

Common Symptoms to Watch For

Many people with heart murmurs experience no symptoms at all. When symptoms do occur, they often develop slowly over time.

Fatigue and exercise intolerance are common early signs. You might notice feeling tired after activities that didn’t bother you before.

Shortness of breath can happen during exercise or even at rest. This occurs when your heart struggles to pump blood effectively.

Some people experience lightheadedness or mild dizziness. This happens when not enough blood reaches your brain.

Swelling (edema) may appear in your legs, ankles, or feet. This fluid retention occurs when your heart can’t pump blood efficiently throughout your body.

These symptoms often start mild and worsen gradually. We recommend tracking when they occur and what triggers them.

Red Flags That Require Urgent Attention

Certain symptoms require immediate medical care. These warning signs suggest your heart murmur may be linked to a serious condition.

Chest pain is always concerning, especially if it’s severe or comes with other symptoms. Fainting (syncope) or near-fainting episodes need urgent evaluation.

These can indicate dangerous heart rhythm problems. Cyanosis – when your lips, fingernails, or skin turn blue or gray – means you’re not getting enough oxygen.

Severe shortness of breath at rest or that wakes you from sleep requires emergency care.

Call 911 if you experience:

Sudden, severe chest pain
Fainting or loss of consciousness
Extreme difficulty breathing
Blue lips or fingernails

Causes and Risk Factors

Heart murmurs and palpitations stem from either structural problems present at birth or conditions that develop over time. Understanding these underlying causes helps determine whether symptoms require immediate attention or routine monitoring.

Congenital and Structural Heart Defects

Congenital heart defects affect about 1 in 100 babies born each year. These structural problems create abnormal blood flow patterns that we can hear as murmurs.

Septal defects are among the most common types. An atrial septal defect creates a hole between the heart’s upper chambers.

A ventricular septal defect causes a hole between the lower chambers. These “holes in the heart” allow blood to flow where it shouldn’t.

Small holes may close on their own as children grow. Larger ones often need surgical repair.

Patent ductus arteriosus happens when a blood vessel fails to close after birth. This creates extra blood flow to the lungs and causes a continuous murmur.

Bicuspid aortic valve affects 1-2% of people. Instead of three valve flaps, there are only two.

This can cause both narrowing and leaking over time. Mitral valve prolapse occurs when valve flaps don’t close properly.

Most cases are mild and cause no symptoms. Coarctation of the aorta narrows the main artery carrying blood from the heart.

Acquired Causes and Systemic Conditions

Many heart murmurs develop later in life due to various medical conditions. Heart valve disease becomes more common with age as valves wear out or become damaged.

Rheumatic fever can permanently damage heart valves. This condition follows untreated strep throat infections.

Rheumatic heart disease remains a leading cause of valve problems worldwide. Endocarditis is a serious infection of the heart’s inner lining.

Infective endocarditis can destroy valve tissue and create new murmurs. People with existing valve problems face higher infection risks.

Cardiomyopathy affects the heart muscle itself. Hypertrophic cardiomyopathy thickens the heart walls and can block blood flow.

High blood pressure forces the heart to work harder. Over time, this can damage valves and create murmurs.

Several other conditions can cause functional murmurs:

Anemia reduces oxygen-carrying capacity
Hyperthyroidism speeds up heart rate
Pregnancy increases blood volume
Fever temporarily increases heart rate

Diagnostic Approaches

Doctors use a systematic approach to diagnose heart murmurs, starting with listening to your heart and progressing to advanced imaging tests when needed. We can identify most murmurs through careful examination, but additional tests help determine their cause and severity.

Physical Examination and Heart Sound Analysis

We begin by listening to your heart with a stethoscope during a physical exam. This process is called auscultation.

We listen at specific spots on your chest to detect unusual sounds. Key listening points include:

Aortic area (upper right chest)
Pulmonary area (upper left chest)
Tricuspid area (lower right chest)
Mitral area (lower left chest)

We ask you to change positions during the exam. You might lie down, sit up, or lean forward.

Some murmurs sound different when you move. We also have you perform simple actions like holding your breath or squatting.

These maneuvers help us tell innocent murmurs from serious ones. We grade murmurs on a scale from 1 to 6.

Grade 1 is very soft. Grade 6 is so loud we can hear it without a stethoscope touching your chest.

Key Diagnostic Tests

We order specific tests when we need more information about your murmur. An echocardiogram is our most important tool.

This test uses sound waves to create moving pictures of your heart. A transthoracic echocardiogram is the most common type.

We place a device on your chest that shows your heart valves and chambers. We can see blood flow and measure how well your heart pumps.

We use an electrocardiogram (ECG) to check your heart’s electrical activity. This test takes just a few minutes.

The ECG shows us if your heart rhythm is normal and if any chambers are enlarged. A chest X-ray helps us see your heart’s size and shape.

We can spot enlarged chambers or other changes that might explain your murmur. For complex cases, we might recommend a stress test.

This shows how your heart works during exercise. Some murmurs only appear when your heart works harder.

Cardiac catheterization involves inserting a thin tube into your heart through a blood vessel. We use this for detailed pressure measurements when other tests don’t give us enough information.

Cardiac MRI provides very detailed pictures of your heart structure. We order this test when we need the clearest possible images of your heart valves and chambers.

Treatment Options and Management

Treatment approaches vary based on whether heart murmurs and palpitations are innocent or indicate underlying heart disease. Board-certified cardiologists develop personalized treatment plans that may include careful monitoring, medications, or surgical interventions.

Monitoring and Lifestyle Recommendations

Many heart murmurs require no treatment beyond regular monitoring by a cardiologist. Innocent murmurs often disappear on their own over time.

We recommend regular check-ups to track any changes in heart sounds or symptoms. Your cardiologist will determine the appropriate monitoring schedule based on your specific condition.

Lifestyle modifications play a crucial role:

Follow a heart-healthy diet low in sodium and saturated fats
Maintain regular physical activity as approved by your doctor
Manage stress through relaxation techniques
Avoid excessive caffeine and alcohol

Weight management helps reduce strain on your heart. We also advise patients to quit smoking, as tobacco use worsens cardiovascular health.

For palpitations triggered by anxiety or stress, lifestyle changes often provide significant relief without medication.

Medical Therapy and Interventions

When heart murmurs indicate valve problems or other conditions, medications help manage symptoms and prevent complications.

Common medications include:

Beta-blockers to control heart rate and reduce palpitations
Diuretics to decrease fluid buildup and reduce heart workload
Blood thinners to prevent clot formation
ACE inhibitors to lower blood pressure

We prescribe specific medications based on your underlying condition. Patients with valve disease may need different treatments than those with innocent murmurs.

Some conditions require antibiotics before dental procedures to prevent heart infections. Your cardiologist will determine if this applies to your situation.

Regular medication monitoring ensures optimal dosing and identifies any side effects early.

Surgical and Minimally Invasive Solutions

Severe valve problems causing significant murmurs may require surgical intervention when medications alone aren’t sufficient.

Valve repair preserves your natural valve structure whenever possible. This option typically offers better long-term outcomes than replacement.

Valve replacement becomes necessary when repair isn’t feasible. We use either mechanical or biological valves depending on your age and lifestyle.

Transcatheter aortic valve replacement (TAVR) provides a less invasive option for elderly patients or those at high surgical risk. This procedure doesn’t require open-heart surgery.

Other minimally invasive techniques include balloon valvuloplasty and catheter-based repairs. These approaches reduce recovery time and hospital stays.

We evaluate each patient individually to determine the most appropriate surgical approach based on valve condition, overall health, and personal preferences.

Living With Heart Murmurs and Palpitations

Most heart murmurs are harmless and don’t require significant lifestyle changes, while palpitations often improve with proper management.

Prognosis and Long-Term Outlook

Innocent heart murmurs have an excellent prognosis. We don’t need treatment or lifestyle changes for these harmless sounds.

They don’t affect life expectancy or quality of life. Most childhood murmurs disappear by adulthood.

Children with innocent murmurs can participate in all normal activities. We should expect no limitations on sports or physical activities.

For murmurs caused by valve problems, the outlook depends on severity. Mild valve issues often require only monitoring.

We can live normal lives with regular check-ups. Palpitations from stress or caffeine usually resolve with lifestyle changes.

We can expect significant improvement within weeks of making adjustments. Most people with occasional palpitations live completely normal lives.

Maintaining Optimal Cardiovascular Health

Regular exercise strengthens our heart health and reduces palpitations. We should aim for 150 minutes of moderate activity weekly.

Walking, swimming, and cycling are excellent choices. Managing stress helps control both murmurs and palpitations.

Deep breathing exercises and meditation reduce symptoms. We should practice relaxation techniques daily.

Dietary changes support our cardiovascular health:

Limit caffeine and alcohol
Reduce sodium intake
Eat plenty of fruits and vegetables
Choose whole grains over processed foods

Sleep quality affects our cardiac output and rhythm. We need 7-9 hours of sleep nightly.

Good sleep hygiene reduces palpitation frequency. Regular medical follow-ups ensure proper monitoring.

We should keep all cardiology appointments. Blood pressure checks and heart rhythm monitoring help track our progress.

Avoiding triggers prevents symptom flare-ups. We should identify and limit caffeine, stress, and other personal triggers.

Keeping a symptom diary helps us recognize patterns.

Conclusion: Don’t Ignore What Your Heart Is Telling You

While most heart murmurs and palpitations are harmless, some may indicate underlying heart conditions that deserve medical attention. Recognizing the difference between benign and concerning symptoms is key to staying ahead of serious complications. Regular check-ups, healthy habits, and stress management can go a long way in keeping your heart strong and steady.

If you’ve noticed unusual heartbeats or sounds, don’t wait. Book an appointment with Cardiovascular Group (CVG Cares) today to get expert answers and peace of mind.