House Calls: Heart murmur may not be all that big a deal

Submitted

House Calls runs every two weeks. Today's column is written by Randy Landenberger registered diagnostic cardiac sonorophone at Sutter Coast Hospital.

There's a murmur going' around this town. Word is, dang near everyone's got one. A heart murmur, that is.

So what exactly is a murmur and why do so many patients state, "Well I've never had one before."

The first definition is that a murmur is an extra sound your doctor or nurse hears when they place the stethoscope over your heart. Typically we expect to hear the classic "boom-boom, boom-boom." Any other sound is a murmur. Those "boom-booms" are made by your heart valves closing. You have four valves, two on each side of the heart, and they close two at a time.

Most murmurs we hear are caused by the valves. Some problems you're

born with, and some you develop over time, either due to normal wear and

tear of aging, or some type of trauma, such as exposure to disease or

drugs.

Heart valves are similar to your sink faucet at home. When the valve

is open, blood flows through, and when it's closed, it's stopped from

flowing backward. So any valve can have two problems; either it gets

clogged or it leaks. A clog is called stenosis, or stenotic, and

primarily caused by calcium buildup. A leak is called regurgitation or

insufficiency.

Before we go any further, let's talk about how we rate any murmur:

andbull; Trivial: Insignificant, don't even bother me with it.

andbull; Mild: No big deal. Almost everyone has some kind of trivial to mild

murmur, even if your doctor never mentioned it (and there's good reason

for that).

andbull; Moderate: You may or may not feel the effects of this, typically

with symptoms of shortness of breath, difficult breathing with moderate

exertion and possibly edema (fluid retention such as swollen ankles) or

CHF (congestive heart failure).

andbull; Severe: Yes you are feeling this one with shortness of breath,

probably need to sleep with two or three pillows, or even sleeping

sitting in your recliner. You can't walk very far without having to stop

and catch your breath.

When your murmur is rated severe, it's time for that conversation

with your cardiologist to develop a plan for that valve's repair or

replacement. You may have a few years, but he or she will want to watch

it closely. You'll probably be in for an echocardiogram every six months

and schedule your surgery before it gets critical.

Once a valve murmur is critical, and there are other health or

frailty problems, then the surgeon may decline to operate. But if you're

in otherwise good health, then all is not lost. In some cases the valve

can still be replaced and the patient can go on to have many years of

healthy living.

So why don't many doctors mention that you have a murmur, or if they

do, they don't explain much? If they can hear that it's trivial or mild,

there's no reason to cause undo alarm. There is nothing you can do to

improve it. Neither exercise nor diet will diminish a murmur.

They often want to know more about the murmur before they tell you.

The best information they can get without sticking wires and tubes in

from your groin and up to your heart usually comes from the

echocardiogram, which can see and quantify the murmur on the trivial to

critical scale.

Sometimes valve leaking is not due to a problem with the valve

itself, but that the heart has become so stretched out and dilated from

another disease, that the valve cannot close competently. If the

underlying disease can be addressed, then the heart may shrink back to

its normal size and the leakage is significantly reduced.

Illicit IV drug use is another big killer of valves. Cocaine and meth

are like running bleach through your faucet, they destroy your whole

heart - the muscle and the valves. The unsterile technique also

introduces bacteria and viruses that love to eat heart valves.

You may have been born with a mildly abnormal valve. No big deal and

not cause for concern until you go to the dentist or need some type of

surgery. That's why every dentist's form that you fill out asks about a

murmur. Your mouth is full of staph germs and during dental work, if

there's blood, then it may provide a direct path for that staph to get

to your heart. In a normal person, the immune system takes care of it,

but with an abnormal valve, it's like taking a fork to your Teflon pan;

Everything (like the staph) will stick to it.

If you do need a valve replaced, you have two options; a mechanical

valve (metal and plastic), or a tissue valve taken from a cow (bovine), a

pig (porcine), a human (a homograft or allograft). Each type has its

advantages and challenges. The good news is that most of them are

lasting 15 years or more. Although they may be rated for 10 years, I

often see patients who've had them going on 20 years.

The other common types of murmurs are from a hole in your heart

between the right and left sides. Unless you've come into contact with

bullets, knives, arrows, spears or daggers from your lover's eyes, then

you were born with it. You don't acquire them as you age, but you may

well heal them as you get older.

The most common type is more like a doorway than an out and out hole.

Some doors will open at the slightest breeze, others need a strong

shoulder to push open. We are all born with the doorway and it needs to

be open while we are in the womb. For most of us, when you take that

very first breath or cry when you make your appearance here on earth,

that's when the door slams shut.

The healing process is like painters covering the wall and door

without taping it off - they literally paint the door closed. For the

others, the painters were on vacation when you were born so the door

remains functional.

Most of your life, having a door that opens is no big deal, it

probably won't affect you at all. However it can come into play if

you've ever had a stroke caused by a blood clot or built up nitrogen

bubbles in your blood when scuba diving. And there's still research as

to whether it may contribute to migraine headaches.

If you do have an actual hole, without a door that closes, whether or

not to have it fixed depends on how large it is, where it is, and if

there's any accompanying problems.

There are a few other varieties, but another "unexplained" one is

exactly that, no visible cause. Your doctor hears an extra sound and the

echo shows nothing. We'll call this a flow murmur.

Picture yourself down by the Smith River on a sunny, warm summer day.

Nice. Quiet and peaceful. The river flows by and you don't hear much at

all. A few months later after the rain, the river is roiling and now

quite loud. The river is not bad or diseased, it just has more water and

more rocks and branches to go around.

Same with your heart, there may just be more tissue inside the heart

for the blood to go around, or your heart is squeezing more tightly.

So to answer your statement: "I've never had a murmur before."

Guess that's because you've lived long enough to acquire it. Your

brand new faucet probably worked fine for a lot of years too, and if you

live in the house long enough, you knowandhellip;

Email suggestions for future House Calls columns to Beth Liles at Sutter Coast Hospital, lilesbe@sutterhealth.org

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