How Is a Heart Murmur Diagnosed?

Doctors use a stethoscope to listen to heart sounds and hear heart murmurs. They may detect heart murmurs during routine checkups or while checking for another condition.

If a congenital heart defect causes a murmur, it's often heard at birth or during infancy. Abnormal heart murmurs caused by other heart problems can be heard in patients of any age.

Specialists Involved

Primary care doctors usually refer people who have abnormal heart murmurs to cardiologists or pediatric cardiologists for further care and testing.

Cardiologists are doctors who specialize in diagnosing and treating heart problems in adults. Pediatric cardiologists specialize in diagnosing and treating heart problems in children.

Physical Exam

Your doctor will carefully listen to your heart or your child's heart with a stethoscope to find out whether a murmur is innocent or abnormal. He or she will listen to the loudness, location, and timing of the murmur. This will help your doctor diagnose the cause of the murmur.

Your doctor also may:

• Ask about your medical and family histories.
• Do a complete physical exam. He or she will look for signs of illness or physical problems. For example, your doctor may look for a bluish color on your skin. In infants, doctors may look for delayed growth and feeding problems.
• Ask about your symptoms, such as chest pain, shortness of breath (especially with physical exertion), dizziness, or fainting.

Evaluating Heart Murmurs

When evaluating a heart murmur, your doctor will pay attention to many things, such as:

• How faint or loud the sound is. Your doctor will grade the murmur on a scale of 1 to 6 (1 is very faint and 6 is very loud).
• When the sound occurs in the cycle of the heartbeat.
• Where the sound is heard in the chest and whether it also can be heard in the neck or back.
• Whether the sound has a high, medium, or low pitch.
• How long the sound lasts.
• How breathing, physical activity, or a change in body position affects the sound.

Diagnostic Tests and Procedures

If your doctor thinks you or your child has an abnormal heart murmur, he or she may recommend one or more of the following tests.

Chest X Ray

A chest x ray is a painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test is done to find the cause of symptoms, such as shortness of breath and chest pain.

EKG

An EKG (electrocardiogram) is a simple test that detects and records the heart's electrical activity. An EKG shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.

This test is used to detect and locate the source of heart problems. The results from an EKG also may be used to rule out certain heart problems.

Echocardiography

Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, is a painless test that uses sound waves to create pictures of your heart. The test gives information about the size and shape of your heart and how well your heart's chambers and valves are working.

Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by lack of blood flow.

There are several types of echo, including a stress echo. This type of echo is done before and after a stress test. During this test, you exercise (or are given medicine if you can't exercise) to make your heart work hard and beat fast.

A stress echo shows whether you have decreased blood flow to your heart. This is a sign of coronary heart disease (also called coronary artery disease).

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