Heart murmur in adults

A heart murmur is an extra sound heard during a heartbeat, caused by turbulent blood flow through the heart, most often related to a heart valve that is either narrowed or leaking. In adults, murmurs more often relate to an underlying structural change, such as valve disease, compared with the frequently innocent murmurs seen in children. Not all murmurs in adults are serious, but they generally warrant assessment to identify the cause.

Common causes include age-related valve degeneration (such as aortic stenosis), valve disease from previous rheumatic fever, congenital heart abnormalities that were not previously identified, or, in some cases, a physiological murmur related to increased blood flow, such as during pregnancy or with anaemia. Identifying the specific cause usually requires an echocardiogram. Some murmurs in adults, particularly softer ones without other symptoms, can still be benign.

Symptoms that suggest a murmur needs prompt assessment include breathlessness, chest pain, fainting or dizziness, palpitations, or reduced exercise tolerance. A murmur discovered incidentally without any of these symptoms is less likely to represent a significant problem, though it should still generally be assessed to confirm this. A cardiologist can determine the likely significance based on the specific characteristics of the murmur combined with your symptoms.

It depends on the underlying cause: some murmurs relate to mild, stable valve changes that need only periodic monitoring, while others indicate more significant valve disease that may eventually need treatment, including surgery. Getting an accurate diagnosis through an echocardiogram is important to determine which category applies to you. Even significant valve disease, once identified, can usually be well managed with monitoring and, when needed, effective treatment.

Investigation typically starts with a thorough clinical examination, followed by an echocardiogram (heart ultrasound) to directly visualise the heart valves and overall heart structure and function. Additional tests such as an ECG or exercise testing may be used depending on the specific findings. A cardiologist interprets these results together with your symptoms to determine any need for treatment or ongoing monitoring.

Treatment depends entirely on the underlying cause: many murmurs need no treatment beyond periodic monitoring, while significant valve disease may eventually require medication or, in more advanced cases, valve repair or replacement surgery. The specific approach and timing of any treatment is guided by the severity of the valve problem and your symptoms. A cardiologist develops an individualised monitoring or treatment plan based on echocardiogram findings.

A benign or "flow" murmur in adults, sometimes related to conditions like anaemia or pregnancy that increase blood flow, is typically softer and occurs without other cardiac symptoms or structural abnormality on echocardiogram. A pathological murmur relates to an actual structural change, most often valve disease, and may be associated with symptoms such as breathlessness or chest pain, with specific abnormal findings on echocardiogram. This distinction is why any newly discovered murmur in an adult is generally assessed with an echocardiogram rather than assumed to be benign.

See a cardiologist if a murmur is newly found, especially alongside symptoms like breathlessness, chest pain, dizziness, or palpitations. A private cardiology assessment including an echocardiogram can typically be arranged within about one to two weeks, often considerably faster than routine NHS referral. Even an incidentally found murmur without symptoms is worth having formally assessed to clarify the cause and any need for monitoring.