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Heart murmurs and heart valve disease

Q: I’m 34 years old and quite sedentary. Recently I feel slightly out of breath when I walk faster.  My GP tells me I have a heart murmur. What does this mean and should I be concerned?

A: Heart murmurs are abnormal sounds that the heart makes that are usually picked up by the doctor when listening with a stethoscope.  Heart murmurs can be harmless or they may be due to heart valve disease. Heart valve disease occurs when one or more of the heart valves fail to work properly. There are 4 heart valves: the aortic, mitral, tricuspid and pulmonary valves. These valves work to ensure that blood circulates normally within the heart. Valves can become too tight and impede blood flow. This is known as valvular stenosis, or they may fail to close normally leading to backflow or regurgitation of blood.

Some people are born with heart valve disease, while others acquire it later in life.  Heart valve disease that develops from birth is called congenital heart valve disease, and is due to heart valves not forming properly. These valves may not have enough tissue flaps, they may be the wrong size or shape, or they may lack an opening through which blood can flow properly. In acquired heart valve disease, the valves are initially normal, but develop problems over time. Examples include degenerative valve disease, valve infections, and valvular inflammation. Other diseases of the heart may also affect the valves, such as coronary heart disease and cardiac muscle diseases which may lead to enlargement of the heart chambers and subsequent valve failure. Some people with heart valve disease have no symptoms, and for some, the condition stays the same throughout their lives and doesn’t cause any problems. For others, the disease may worsen until symptoms develop. Symptoms include breathlessness especially on exertion, fatigue, irregular, fast or strong heart beats, chest tightness or pain. It may even cause dizziness and fainting if severe. In these cases, if left untreated, advanced heart valve disease can lead to heart failure, stroke or death from sudden cardiac arrest.

At present there are no medications that cure heart valve disease, although healthy lifestyle and medications may relieve many of the symptoms and reduce the above complications. Eventually, the faulty heart valve may need to be surgically repaired or replaced. A cardiologist is the best person to assess the heart valves. This can be done with cardiac ultrasound also known as echocardiogram to visualise the valve function real time. Further specialised ultrasound techniques such as 3-dimensional (3D) ultrasound, trans-oesophageal and stress echo can allow more precise evaluation of the valve in order to determine the safety of exercise and determine the need for surgery, as well as the type and timing. There are several options for valve surgery, including open heart surgery to repair the valve or replace it with a metallic valve, or a prosthetic one made of animal tissue. More recently, minimally invasive techniques may be an option for selected patients. In these cases, instead of open heart surgery, the valve may be treated percutaneously through the insertion of small catheters into the heart via the blood vessels. As no open heart surgery is involved, there is no surgical scar, much less post operative pain, faster recovery, and the risk of the procedure is also generally lower.

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peter_ting
Medical Director and Cardiologist

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