Heart Murmur

Q:  My daughter, who is 39 years old, was told by her physician at her last yearly exam that she has a heart murmur caused by a faulty valve. The only advice he gave her was to treat a strep throat seriously, if she would have one. I am concerned about this and feel it should be looked at more closely. I, myself, have had an artificial heart valve since 1983, and I would like to take her with me on my next appointment to my cardiologist. What is your opinion?

A:  When listening to the normal heart with the stethoscope, there should be two sounds--"lub dub." These are the sounds made when the 4 heart valves close: the tricuspid and mitral close at the same time making the "lub" sound, and the pulmonary and aortic close during the "dub" sound. Murmurs are swishing sounds created when there is a narrow opening because the valve is scarred or diseased and the blood has to force its way through, or when the valve doesn't close tightly and blood is leaking backwards. There can also be innocent murmurs, especially in children, when an extra sound is heard, but the valve is really fine. People can also have murmurs that remain unchanged for years and never lead to heart problems or require valve surgery.

The reason her doctor told her to take a step throat seriously is that infections elsewhere in the body can travel in the blood stream and infect a faulty heart valve, potentially leading to major damage and eventual surgery. That is also why a person with a heart murmur needs to take antibiotics before and after dental work or certain procedures where blood and bacteria may be involved.

If your daughter is also worried about the murmur, she should first ask her own doctor about it. Which valve is involved? What does it mean...? An experienced physician and/or cardiologist is usually able to tell which valve is involved by the location, timing, and characteristics of the murmur. If indicated, he will order an echocardiogram, which looks at valves, blood flow, and heart motion using sound waves.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.