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Heart Murmurs

By: Dr. Debra Primovic

Section: Overview

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Heart murmurs are auscultatory sounds created by turbulent or disturbed blood flow through the heart or vasculature. They can be heard over any region of the heart and can be associated with a variety of causes. Murmurs can be caused by congenital malformations of the heart, acquired heart disease, or by other diseases that can affect the heart but are not caused by an underlying heart disease.

Murmurs can indicate abnormal heart valve, heart muscle disease, a congenital patency (an abnormal opening) between sides of the heart, anemia, heartworm disease, abnormal thyroid function, or be "functional" which does not indicate heart disease. Some murmurs heard in puppies and kittens will disappear as the pet ages (usually < 4 months).

Murmurs are often classified based by their location, timing, duration, character and grade. For example:

Location refers to the area of the heart in which the sound appears to originate.

It is usually described by the sounds proximity to a valve area such as the aortic, mitral, tricuspid or pulmonic or relative to body structures such as left apex or sternal border.

Timing refers to when the murmur occurs during the heart beat cycle. It is most often described as systolic, diastolic or continuous.

Duration refers to how long the sound lasts within the timing phase.

Character of the murmur refers to the quality of the sound such as if the murmur gets louder than softer during the heart's cycle. Words often used to describe the murmurs "character" includes plateau, regurgitant type, crescendo, decrescendo, crescendo-decrescendo, ejection, or machinery.

Grade refers to the intensity of the sound. The scale is generally from 1 to 6 with 1 being the softest and 6 being the loudest. Some murmurs are accompanied by a "thrill" which indicates that the murmur is so loud it causes a palpable vibration that can be felt over the chest wall.

The classification of the murmur is used to help determine possible causes for the murmur, however, this can be difficult. Additional tests may be required such as an echocardiogram.

How are Murmurs Created?

Each heartbeat originates as an electrical impulse and eventually generates a muscular movement. The heart is a muscle that's "job" is to pump blood. Blood is pumped from the body to the heart, processed through the lungs, returned back to the heart and pumped out to the body. As the blood is pumped, it goes through four different parts of the heart or heart chambers. Between these chambers are "valves". A valve is a membrane that opens and closes to prevent backward flow of blood.

Heart murmurs can be caused from either heart muscle or valve abnormalities. If either of these structures do not function properly, the flow of blood is disturbed. This disturbance can cause "turbulence" in the blood flow that creates an abnormal sound that we refer to as a "murmur".

Heart murmurs may affect dogs of any age or sex. They may also affect any breed, however some breeds are more prone to heart disease.

The prognosis (outlook) for animals with heart murmurs depends on the underlying cause of the murmur such as the type and extent of any existing heart disease.

What to Watch For

A murmur is an abnormal heart sound and is found only by listening to the heart. Occasionally a vibration or "thrill" can be felt over the heart. Signs of heart disease or secondary problems that may be associated with the mumur may include:

Some pets have no symptoms

Weakness

Collapse

Slow heart rate

Fast heart rate

Erratic heart rate

Difficulty breathing

Lack of appetite

Coughing

Diagnosis

When a murmur is present, the goal is to determine the underlying cause for the murmur. Tests may include blood work, urinalysis, chest radiographs and an echocardiogram.

The "gold standard" for diagnosing the underlying cause of a heart murmur is a cardiac ultrasound (echocardiogram). It is performed to evaluate cardiac and valve function and identify underlying heart disease. Murmurs that occur in puppies and kittens can be very difficult to diagnose even for the most experienced veterinarians. Many pets may be referred to a board certified veterinary cardiologist for evaluation.

Thoracic (chest) radiographs (X-rays) may help determine if heart disease or heart failure is present.

Blood work, including a complete blood count and biochemical profile, may be performed to look for any underlying abnormalities. Some dogs may be anemic, have an elevated white blood cell count, or have other organ dysfunction.

How aggressively one pursues the underlying cause of the murmur depends upon the likelihood of a serious underlying problem and if there are any other associated symptoms indicating the probability of heart disease.

Possible Causes of Murmurs

Murmurs can be caused by a variety of cardiac and noncardiac diseases. Some diseases that can affect the heart but are not caused by an underlying heart disease.
Cardiac Causes of a Murmur

Subaortic stenosis

Pulmonary stenosis

Septal defects

Atrioventricular dysplasia

Tetralogy of Fallot

Mitral Stenosis

Aortic Valvular Insufficiency

Pulmonic Valvular insufficiency

Patent Ductus Arteriosus

Arteriovenous fistula

Cardiomyopathy

Endocardiosis or Chronic Valvular Heart Disease

Noncardiac Causes of a Murmur

Fever

Anemia

Infection causing endocarditis

Thyroid disease

Heartworm disease

Pericardial disease

Tumors

Obesity

Cachexia

Pregnancy

Treatment

Treatment depends on the underlying disease. There are a variety of causes of heart murmurs and each is managed differently. Some are serious and require medication or even surgery. Others are innocuous and do not require any treatment at all.

Prognosis

The prognosis of pets with a murmur is variable. It depends on the underlying cause for the murmur.

Home Care and Prevention

There is no home care for heart murmurs, except that you should administer any medications your veterinarian prescribes. If you suspect that your pet has a heart murmur, you should discuss diagnostic options with your veterinarian. Animals with heart murmurs should be monitored periodically to determine if disease is progressive.