Most people are familiar with the term heart murmur but don't know exactly what it refers to. It is simply an abnormal sound that the heart makes when blood flows through it. This sound or "murmur" is heard by a doctor who auscultates the heart with a stethoscope. This is not a disease, but it still indicates that the heart muscle is not functioning perfectly. Depending on the severity of the heart murmur, medical treatment may be required.
Steps
Part 1 of 3: with Drugs
Step 1. Take ACE inhibitors
Hypertension can worsen the underlying cause of the heart murmur. Angiotensin converting enzyme inhibitors work by dilating blood vessels, thus reducing pressure and subjecting the heart to less stress.
- ACE inhibitors help treat symptoms of a contracted or insufficient heart valve.
- Enapril is an ACE inhibitor to be taken orally. The dose, which ranges from 10 to 40 mg per day, can be divided into two distinct moments.
Step 2. Try digoxin
This drug increases the strength and vigor of heart contractions. This is useful if the murmur is caused by an underlying condition that weakens the heart muscle.
Digoxin (Lanoxin) is taken orally every day in doses of 0.125-0.25 mg
Step 3. Try beta blockers
This category of drugs works by relaxing blood vessels and slowing the heart rate to improve blood flow and lower blood pressure. They should be taken when mitral valve prolapse and palpitations are present.
Carvedilol is a beta-blocker, the dosage involves taking orally 3, 25-25 mg per day twice a day
Step 4. Take blood thinners
Some heart valve diseases are caused by pooling of blood in the heart which causes clots. These, in turn, are responsible for heart attacks and strokes. Anticoagulants are drugs that are used to prevent blood clots from forming.
Clopidogrel (Plavix) is a widely used anticoagulant drug that is taken orally every day (75 mg)
Step 5. Ask your doctor to prescribe diuretics
These medicines increase the secretion of water from the body through the urine. They are adjuvants in the treatment of hypertension or excess fluids sometimes responsible for a worsening of heart murmur.
Furosemide (Lasix) is a diuretic that is usually prescribed in doses of 20-40 mg every 6-8 hours
Step 6. Use statins to lower cholesterol
If you have high cholesterol, this could potentially worsen heart valve problems, including heart murmurs. There are few statins on the market that can be used to lower cholesterol.
Atorvastatin (Lipitor) is probably the most widely used drug in the world. It must be taken daily and the dose ranges from 10 to 80 mg
Step 7. Get a course of antibiotics
This category of drugs is used to treat endocarditis (inflammation of the inner lining of the heart chambers and valves) caused by a bacterial infection. It usually takes several weeks of treatment.
- A therapy often practiced involves the intake of 1.2 g Benzylpenicillin every 4 hours and 1 mg / kg of gentamicin every 8 hours.
- This is a very long but necessary treatment to avoid further damage to the heart valves. As always, it is essential to complete the course of antibiotics.
Part 2 of 3: with Surgery
Step 1. Undergo valvuloplasty
It is a procedure that aims to open a blocked valve. A balloon catheter is inserted through a blood vessel which is then guided to the heart valve.
- A counterstain is also inserted with the catheter to improve visibility. The balloon is inflated to open the valve, once the valve has been treated, the balloon deflates and is removed.
- While you will be heavily sedated during the procedure, you will still remain alert throughout the surgery. After the valvuloplasty you will have to rest in bed and you will be advised to drink a lot to expel the contrast fluid.
- This procedure is used to correct age-related calcification of the valve, such as mitral valve stenosis.
Step 2. Consider valvulotomy
This intervention increases the restricted opening of the valve. It is practiced for patients with mitral, tricuspid, pulmonary and aortic valve stenosis. There are two techniques for this procedure: valve open and valve closed.
- With the valve closed: an incision is made in the left atrial appendage with the 'purse string' technique. A Tubbs dilator is inserted into the left ventricle from the apex and the valve is opened. This procedure is currently rarely performed.
- Valve Open: Performed through a cardiopulmonary bypass following a median sternotomy (opening the sternum) A Tubbs dilator is used to open the valve and remove calcium deposits.
Step 3. Try a valve rebuild
During this surgical practice you are sedated until just before a cardioplegic arrest, which means that the heart is momentarily stopped and that breathing and blood circulation are guaranteed by a machine outside the body.
- The breastbone is incised or a cut is made under the right pectoral muscle. The damaged valve is exposed and checked. The surgeon determines the cause of the damage and repairs the valve accordingly.
- The valve repair technique involves: the removal of calcium deposits and other substances from the valves, the remodeling and redefinition of its dimensions, the repair of the structures that control the movements of the valve and the reconnection of the valve itself to them. This procedure strengthens and supports the base of the valve.
Step 4. Consider a valve replacement
This procedure is done when the valve has become stenotic or leaking causing blood to reflux into the heart instead of pushing it further in its path. The surgeon proceeds with a sternotomy (opening of the breastbone) or with a series of small incisions. There are two types of valves that are used in this circumstance: artificial or biological (xenograft and homograft).
- Lures: they can be ball-shaped (Starr-Edwards), folding disc (Bjork-Shiley) or double folding disc (St Jude). They are very resistant but are at risk for thrombo-embolism (formation of clots in the blood vessels that can break off, run along the same vessels and block others. Lifelong therapy with anticoagulants will be necessary.
- Xenografts: they are of animal origin, pig to be precise, or consist of a thin layer coated with pericardium (heart tissue). They are valves that have a lower resistance and need to be replaced every 8-10 years. Anticoagulation therapy is not necessary unless atrial fibrillation (rapid and irregular heartbeat) is present.
- Homografts: are valves of human origin, explanted from a donor. They are particularly useful for young patients and when replacing an infected valve.
Part 3 of 3: Understanding Heart Murmur in Adults
Step 1. Know that there are two types of heart murmurs:
abnormal and congenital:
- Non-pathological: The person with this type of heart murmur has no heart disease and their heart is practically normal. These murmurs are heard because the flow of blood through the heart muscle is rapid. There is no symptomatology or pathological sign. Non-pathological heart murmurs can disappear over time or remain for life without causing any health problems.
- Abnormal: This is a symptom of a heart problem, usually related to the heart valve. The valve may be too contracted or show growths; if left untreated, the problem can become serious.
Step 2. Identify possible causes of non-pathological heart murmur
Eg:
- Pregnancy.
- Physical activity or training.
- Anemia.
- Fever.
- Hyperthyroidism.
Step 3. Identify the causes of abnormal heart murmurs
As mentioned earlier it can be caused by a heart valve problem. The underlying pathologies that can be responsible are:
- Rheumatic fever.
- Bacterial endocarditis.
- Calcification of the valve linked to age.
- Prolapse of the mitral valve.
Step 4. Recognize the symptoms of an abnormal heart murmur
These are not present in non-pathological cases. It is a disease that doctors discover during a routine physical exam, so it is important to have regular checkups. If you suspect your heart murmur is related to heart valve disease, check for:
- Chest pain.
- Shortness of breath.
- Fatigue and dizziness.
- Excessive sweating with little or no effort.
- Bluish color of the skin especially the fingertips and lips.
- Chronic cough.
- Swollen ankles or sudden weight gain.
- Enlarged liver.
- Enlarged neck veins.
Step 5. Understand how heart murmur is diagnosed
You will need to undergo several tests before an official diagnosis of abnormal heart murmur is made. Here's what awaits you:
- Chest X-ray: this non-invasive procedure gives an image of the internal structure of the patient's chest. The doctor checks for the presence of fluid in the lungs, if the heart is enlarged, if there is fluid around the lungs or if the wall that separates the two heart cavities is thinned.
- ECG: the electrocardiogram records the electrical activity of the heart. It is performed by applying small electrodes to the patient's chest, arms and legs to monitor electrical activity.
- Echocardiogram: this is the main exam for evaluating heart murmurs. It is normally called 'Echo' and it is a non-invasive procedure that uses sound waves to reconstruct, through a computer, the image of the heart. Basically it's an ultrasound of the heart.
- Blood tests: These check for possible infections in patients with suspected bacterial endocarditis which in turn can cause an abnormal heart murmur.
