"Your child has a heart murmur." Few phrases can make a parent's heart skip a beat quite like this one. But here's something that might surprise you: up to 80% of children will have a heart murmur at some point during their childhood, and the vast majority are completely harmless.
Heart murmurs are far more common than most people realize, and understanding them can save you from unnecessary worry. Let me explain what a heart murmur really is, when it's a sign of something serious, and when you can simply relax.
In This Article
What Is a Heart Murmur?
A heart murmur is simply an extra or unusual sound heard during a heartbeat. When your doctor listens to your heart with a stethoscope, they normally hear a rhythmic "lub-dub" sound. This is the sound of your heart valves opening and closing as blood flows through.
A murmur sounds like a whooshing, swishing, or rasping noise between these heartbeats. Think of it like water flowing through a garden hose. Normally, water flows smoothly and quietly. But if there's a kink or narrowing in the hose, you might hear a rushing or whooshing sound as the water passes through.
Important to Understand
A heart murmur is not a disease—it's a sound. Sometimes this sound indicates a problem with the heart, but often it's completely normal.
Innocent Murmurs vs. Abnormal Murmurs
✓ Innocent (Harmless) Murmurs
Also called "functional" or "physiologic" murmurs, these are completely harmless sounds produced by blood flowing normally through a healthy heart.
Common in:
- • Children ages 3-6 (peak age)
- • Teenagers and young adults
- • Pregnant women
- • People with fever or anemia
Characteristics:
- • Soft and musical quality
- • Only during pumping phase (systolic)
- • Changes with position/activity
- • No other heart disease symptoms
⚠ Abnormal (Pathological) Murmurs
Caused by structural problems in the heart that may need treatment.
Causes include:
- • Damaged or abnormal heart valves
- • Holes in the heart walls
- • Congenital heart defects
- • Heart muscle problems
Characteristics:
- • Louder or harsher sounding
- • May occur in relaxing phase (diastolic)
- • May be accompanied by symptoms
- • Present from birth or develops later
According to research published in the American Family Physician journal, most murmurs discovered in children, especially after infancy, are innocent and can be monitored with regular check-ups without extensive testing.
What Causes Heart Murmurs?
Causes of Innocent Murmurs
Innocent murmurs occur when blood flows faster or with more turbulence through the heart. Common triggers include:
- Fever: Illness speeds up the heart rate
- Anemia: Lower red blood cells means the heart pumps faster
- Physical activity: Exercise naturally increases heart rate
- Pregnancy: Blood volume increases by 30-50%
- Hyperthyroidism: Overactive thyroid speeds metabolism
- Rapid growth in children: Heart may grow at different rates
Causes of Abnormal Murmurs
In Children (Congenital):
- • Holes in the heart (ASD, VSD)
- • Patent ductus arteriosus
- • Abnormal heart valves from birth
- • Tetralogy of Fallot
In Adults (Acquired):
- • Aortic stenosis (narrowed valve)
- • Mitral regurgitation (leaky valve)
- • Rheumatic heart disease
- • Endocarditis (valve infection)
- • Age-related valve degeneration
A 5-year study from Auckland City Hospital found that among adults with asymptomatic heart murmurs, the most common significant findings were aortic stenosis and mitral regurgitation. Patients over 65 were more likely to have structural heart disease (16% vs 11%).
Symptoms to Watch For
An innocent murmur typically causes no symptoms at all. It's discovered incidentally during a routine examination.
Red Flags That May Suggest an Abnormal Murmur:
In Infants:
- • Poor feeding or tiring during feeds
- • Rapid breathing
- • Blue tint to lips, tongue, or fingertips (cyanosis)
- • Poor weight gain
- • Excessive sweating during feeds
In Children:
- • Shortness of breath during normal activities
- • Tiring more easily than peers
- • Blue discoloration during exercise
- • Fainting or dizziness
- • Chest pain
In Adults:
- • Shortness of breath, especially when lying down
- • Fatigue with mild exertion
- • Swelling in ankles or feet
- • Irregular heartbeat (palpitations)
- • Chest pain or dizziness
Seek Immediate Medical Attention If You Notice:
- • Blue discoloration of the skin
- • Sudden chest pain
- • Fainting
How Are Heart Murmurs Diagnosed?
Physical Examination
The first step is always a careful physical examination. Your doctor will:
- 1. Listen with a stethoscope: They'll check different areas of your chest to hear where the murmur is loudest, its timing, pitch, and quality
- 2. Grade the murmur: Murmurs are graded from 1 to 6, with 1 being barely audible and 6 being so loud it can be heard without a stethoscope
- 3. Look for other signs: Checking for abnormal pulses, breathing patterns, or signs of heart failure
Tests That May Be Ordered
Echocardiogram (Echo)
The most useful test—a painless ultrasound that creates detailed images of your heart's structure and function. Shows valve problems, holes, and blood flow patterns.
Electrocardiogram (ECG)
Records your heart's electrical activity. Useful for detecting rhythm problems or signs of heart strain.
Chest X-ray
Shows the size and shape of the heart and lungs.
Note: According to clinical guidelines, ECGs and chest X-rays shouldn't be automatically performed for all murmurs as they can sometimes give misleading results. The echocardiogram is the most valuable test when evaluation is needed.
When Should You See a Cardiologist?
For Children - Referral Recommended If:
- • Murmur detected in a newborn
- • Diastolic murmur (between heartbeats)
- • Loud (grade 3+) or harsh murmur
- • Murmur radiates to back or neck
- • Any symptoms of heart disease
- • Family history of congenital heart disease
For Adults - Referral Recommended If:
- • Newly detected murmur, especially over 50
- • Diastolic murmur
- • Symptoms like shortness of breath or fatigue
- • Accompanied by irregular heartbeat
- • Signs of heart failure
Treatment Options
For Innocent Murmurs
No treatment is needed.
- • No medications required
- • No activity restrictions
- • No regular monitoring beyond routine check-ups
- • No antibiotics before dental procedures
Many innocent murmurs in children disappear as they grow older.
For Abnormal Murmurs
Treatment depends on the underlying cause:
Monitoring:
Mild valve problems may only need regular check-ups with echocardiograms.
Medications:
Blood thinners, diuretics, blood pressure medications, or heart rhythm medications.
Interventional Procedures:
Balloon valvuloplasty or catheter-based valve repair/replacement.
Surgery:
Valve repair or replacement, repair of holes in the heart, or correction of congenital defects.
Frequently Asked Questions
Are heart murmurs dangerous? ▼
Most heart murmurs are not dangerous at all. In fact, up to 80% of children have an innocent heart murmur at some point. These are completely harmless and often go away on their own. Only a small percentage of murmurs indicate an underlying heart problem that needs treatment.
Can a heart murmur go away on its own? ▼
Yes, especially in children. Innocent murmurs often disappear as children grow. Murmurs caused by fever, anemia, or pregnancy typically resolve when the underlying condition is treated. However, murmurs caused by structural heart problems usually don't go away without treatment.
Can I exercise with a heart murmur? ▼
If you have an innocent murmur, you can exercise without any restrictions. If you have an abnormal murmur, your doctor will advise on appropriate activity levels based on your specific condition. Many people with structural heart conditions can still exercise safely with proper guidance.
Should I be worried if my child has a heart murmur? ▼
In most cases, no. Heart murmurs in children are extremely common—up to 80% of children will have one at some point. Most are innocent and require no treatment. However, if your child's doctor recommends seeing a cardiologist, it's important to follow through to rule out any underlying issues.
Do I need antibiotics before dental work if I have a heart murmur? ▼
Not for most heart murmurs. Antibiotics before dental procedures are only recommended for certain high-risk heart conditions, such as prosthetic heart valves, previous endocarditis, certain congenital heart defects, or heart transplant patients with valve problems. Your cardiologist will advise if this applies to you.
Can heart murmurs develop in adults who never had them before? ▼
Yes. Adult-onset murmurs can develop due to age-related valve degeneration, high blood pressure, infections, or other acquired conditions. This is why a new murmur in an adult, especially someone over 50, should be evaluated by a cardiologist.
Do heart murmurs cause symptoms? ▼
Innocent murmurs cause no symptoms—they're only detected during a physical examination. Abnormal murmurs may or may not cause symptoms, depending on the severity of the underlying condition. Symptoms like shortness of breath, fatigue, or chest pain suggest the murmur may be significant.
How often do innocent murmurs turn out to be serious? ▼
Rarely. Studies show that in children beyond infancy, most murmurs are innocent. However, newborn murmurs have higher rates of pathology, which is why referral is often recommended for babies. In adults, especially those over 65, asymptomatic murmurs are more likely to indicate structural heart disease.
References
- Ford B, Lara S, Park J. Heart Murmurs in Children: Evaluation and Management. Am Fam Physician. 2022;105(3):250-261. PMID: 35289571
- Hueckel RM, Leyland C. Pediatric Murmurs. Nurs Clin North Am. 2023;58(3):475-482. PMID: 37536793
- Kueh SH, et al. The not so innocent heart murmur: a 5-year experience. Intern Med J. 2017;47(2):199-205. PMID: 27860144
- Naik RJ, Shah NC. Teenage heart murmurs. Pediatr Clin North Am. 2014;61(1):1-16. PMID: 24267454
About the Author
Dr. Shailesh Singh is a senior interventional cardiologist practicing at Preventia Clinic (Noida) and Fortis Escorts Heart Institute (Delhi). With expertise in cardiac evaluation and echocardiography, he provides comprehensive assessment for patients with heart murmurs and valve conditions.
Learn more about Dr. Singh →Need a Heart Murmur Evaluation?
If you or your child has been diagnosed with a heart murmur and you'd like expert evaluation, Dr. Shailesh Singh can provide comprehensive cardiac assessment.
Locations: Preventia Clinic, Sector 76, Noida | Fortis Escorts Heart Institute, Delhi
Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Every patient's situation is unique. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.