A heart murmur can sound alarming, especially when you hear the word for the first time during a routine checkup. But a murmur is not a diagnosis by itself. It is a sound your doctor hears through a stethoscope when blood moves through the heart in a way that creates extra noise, often described as a whooshing or swishing sound. Some murmurs are harmless. Others may point to an underlying issue that deserves closer attention.
That difference matters. Many people, especially children and younger adults, can have what is called an innocent heart murmur. In these cases, the sound is not a sign of heart disease and may not need any treatment at all. But in other people, especially adults, a murmur can be linked to a problem with a heart valve, a structural issue, or another medical condition that affects blood flow through the heart.
This guide explains what a heart murmur is, what can cause it, which symptoms may be warning signs, and when it is smart to get medical help.
What is a heart murmur?
Your heartbeat normally creates familiar valve-closing sounds. A heart murmur is an additional sound that happens when blood flow becomes turbulent rather than smooth. Doctors may hear it during a physical exam, even if you feel completely fine. A murmur can be present from birth or develop later in life.
It is important to understand that a murmur is a clinical clue, not automatically a disease. Think of it as a signal that tells a doctor to ask a better question: is this harmless blood flow, or is something affecting the heart’s valves, chambers, or workload? That is why one person with a murmur may need no treatment, while another may need further testing.
Innocent vs abnormal heart murmurs
Heart murmurs are often divided into two broad groups: innocent and abnormal. Innocent murmurs happen in otherwise healthy hearts. They are especially common in babies and children, and they may become louder during times when blood is moving faster, such as exercise, pregnancy, fever, anemia, or rapid growth. Innocent murmurs do not reflect heart damage.
Abnormal murmurs are different. These may suggest a structural or functional problem in the heart, especially involving the valves. In adults, abnormal murmurs are commonly linked to valve disease, such as a valve that has become narrowed or leaky. A murmur can also be related to a congenital heart defect, infection, or thickening of the heart muscle. (www.heart.org)
Doctors also pay attention to when the murmur happens in the heartbeat. Timing alone does not make the diagnosis, but it helps guide evaluation. Diastolic murmurs and continuous murmurs are more likely to need investigation, while the pattern of some systolic murmurs may be less concerning depending on the full exam.
Common causes of heart murmurs
The causes of a heart murmur can range from very mild to more serious.
Causes of innocent murmurs
An innocent murmur can happen when blood flows faster than usual through a normal heart. Common examples include fever, anemia, hyperthyroidism, pregnancy, exercise, and growth spurts in childhood or adolescence. These situations increase circulation demands and can make the sound of blood flow easier to hear.
Causes of abnormal murmurs
An abnormal murmur is more likely when something changes the structure of the heart or valves. Common causes include:
- Valve stenosis, where a valve becomes narrowed and harder to open
- Valve regurgitation, where a valve does not close properly, and blood leaks backward
- Congenital heart defects, such as holes in the heart walls
- Endocarditis is an infection that can affect heart valves
- Hypertrophic cardiomyopathy, where the heart muscle becomes abnormally thick
- Age-related valve changes, especially in older adults (nhs.uk)
In adults, heart valve disease is one of the most important causes to rule out. A murmur may be the first sign that a valve is stiff, narrowed, prolapsing, or leaking. Sometimes people have no symptoms early on, which is why a murmur found during a routine exam should not simply be ignored.
What symptoms can happen with a heart murmur?
Many heart murmurs cause no symptoms at all. In fact, a lot of people only learn they have one because a doctor hears it during a physical exam. When symptoms do happen, they are usually related to the underlying cause rather than the sound itself.
Possible symptoms linked to a more concerning murmur include:
- Shortness of breath
- Chest pain or pressure
- Dizziness or lightheadedness
- Fainting
- Heart palpitations
- Unusual fatigue or weakness
- Swollen ankles or feet
- Bluish lips or skin in more severe cases
In infants and children, poor feeding, poor growth, sweating with little activity, or a bluish color may be warning signs that a murmur needs urgent follow-up. In older children, certain exam findings, such as a loud, harsh, or diastolic murmur, are more concerning and may prompt referral to a pediatric cardiologist.
When should you worry about a heart murmur?
A heart murmur should not automatically cause panic, but it should be taken seriously enough to be properly evaluated. The main question is not “Do I have a murmur?” but “Why is the murmur there?” (hopkinsmedicine.org)
You should be more concerned if the murmur comes with symptoms like:
- Shortness of breath during normal activity
- Chest discomfort
- Dizziness or fainting
- Swelling in the feet or ankles
- Recurring palpitations
- Reduced exercise tolerance
- Symptoms that seem to be getting worse over time (nhs.uk)
You should seek urgent medical attention if there is severe chest pain, sudden major breathing difficulty, or chest pain that comes with shortness of breath, sweating, or fainting. Those symptoms can have many causes, but they need prompt care and should not be brushed off as “just a murmur.”
How doctors diagnose a heart murmur
Diagnosis starts with a physical exam. A doctor listens to the heart from different positions on the chest and may pay attention to the murmur’s timing, loudness, pitch, location, and whether it radiates toward the neck or back. They may also listen while you change position, squat, stand, or grip your hands, because those maneuvers can change the sound and offer clues.
If a murmur seems potentially important, the key test is usually an echocardiogram. This ultrasound of the heart shows how the chambers and valves are working and how blood is moving through them. Doctors may also order an ECG or chest X-ray depending on the situation.
In children, referral decisions depend on the full picture. Many childhood murmurs are innocent, but a pediatric specialist may be recommended if the murmur is harsh, holosystolic, diastolic, radiates abnormally, or if the child has symptoms suggesting heart disease.
How are heart murmurs treated?
Treatment depends entirely on the cause. Innocent murmurs do not need treatment because there is no heart problem to fix. In those cases, reassurance may be all that is required.
If the murmur is caused by another condition, treatment focuses on that condition. For example, anemia may need correction, hyperthyroidism may need treatment, and valve disease may require monitoring, medication, repair, or replacement depending on severity. In some people, regular follow-up is enough. In others, especially those with symptomatic or severe valve disease, surgery or a valve procedure may be recommended.
That is why experts often say you do not “treat the murmur” itself. You treat what is causing it.
Can you live normally with a heart murmur?
In many cases, yes. People with innocent murmurs usually live completely normal lives and may not need restrictions. Even when a murmur is linked to a heart condition, many people do well with monitoring and the right treatment plan. The biggest mistake is assuming all murmurs are harmless or, on the other hand, assuming every murmur is dangerous. The right approach is evaluation, not fear.
Final Verdict
A heart murmur is an extra sound heard during the heartbeat, usually caused by turbulent blood flow. Some murmurs are harmless and common, especially in children, during pregnancy, or when blood flow temporarily speeds up. Others may signal valve disease, congenital heart problems, or another medical condition that needs attention. The real concern is not the sound alone, but the cause behind it.
If a murmur comes with shortness of breath, chest pain, dizziness, fainting, swelling, or worsening exercise tolerance, it is worth getting checked. A proper exam and, when needed, an echocardiogram can usually clarify whether the murmur is innocent or something that needs treatment.
FAQ
Is a heart murmur always serious?
No. Many heart murmurs are innocent, especially in children and healthy young people. But some murmurs can signal an underlying heart problem, which is why evaluation matters.
Can a heart murmur go away?
Yes. Innocent murmurs can come and go and may disappear over time. Murmurs related to pregnancy or temporary high blood flow states may also improve when the underlying cause resolves.
What test confirms the cause of a heart murmur?
An echocardiogram is the main test used to determine the cause of a concerning heart murmur. It shows heart structure, valve function, and blood flow.
Can adults have innocent heart murmurs?
Yes, although innocent murmurs are especially common in children. Adults can also have harmless murmurs, particularly during pregnancy, anemia, fever, or other states where blood flow is increased.
When should I see a doctor for a heart murmur?
You should get checked if a murmur is newly discovered, if you have symptoms like breathlessness, chest pain, palpitations, dizziness, or fainting, or if symptoms are worsening.
References
- Mayo Clinic, Heart murmurs — Symptoms & causes. (Mayo Clinic)
- Mayo Clinic, Heart murmurs — Diagnosis & treatment. (Mayo Clinic)
- American Heart Association, Heart Murmurs. (www.heart.org)
- NHS, Heart valve disease. (nhs.uk)
- Johns Hopkins Medicine, When to Evaluate Heart Murmurs. (hopkinsmedicine.org)
- Cleveland Clinic, Heart Murmur: Causes, Symptoms, Treatment. (Cleveland Clinic)
- Johns Hopkins Medicine, Heart Murmurs. (hopkinsmedicine.org)
- MedlinePlus Medical Encyclopedia, Heart murmurs. (MedlinePlus)
- American Academy of Family Physicians, Heart Murmurs in Children: Evaluation and Management. (aafp.org)