Murmurs

[carolinemc]

My GPs listen to my heart and tell me it sounds good. Same thing with my cardiologist. I believe there are certain valve problems that can be heard with the stethoscope. They don't need to have heard your heart before to hear something out of the ordinary, but they do probably have to know what a mechanical valve sounds like. When I was in the hospital, there was more than one intern that wanted to hear my valve both before the AVR and after the AVR to learn what a crapped out valve sounds like and to learn what a new mechanical valve sounds like.

The echocardiogram will help them know what's causing the new sound and if there is cause to take action.

Murmurs have a swooshing sounds that gets louder as things get worse. I was in the know of the murmur swooshing sound since I was 8 years old, watching the cardio reacting and getting a child's education on the repair. I had replacement aortic valve done at age 36 and it was a loud swooshing sound, made my jaw drop when I heard it. It was pretty bad, that is what the doctor hears through a stethoscope. Just think of a person who has heard her valve getting bad over the years. I was informed by the surgeon and kept up with the cardio since surgery. Education and asking question is the key to keeping up.

 

[Paleowoman]

I’m sometimes used as a patient in the MRCP Paces exam, that’s the exam which doctors take who want to move up to consultant level. These doctors have to describe my heart murmur to the examiners, they have to work out which valve is affected, what kind of murmur it is, and what the next step is, eg echocardiogram. (They’re not told I have had AVR and they’re not allowed to ask me questions, though they obviously can see the sternotomy scar which could be due to any number of surgical heart procedures.) When my valve was bicuspid the doctors could easily identify it, but since AVR they often go wrong - some have even thought I have a mitral valve problem as, although I have a very loud ejection systolic murmur they sometimes hear it as a pansytolic murmur and sometimes “all over the pericardium” - I hear all these phrases, it’s a real lesson for me in how difficult it is for doctors to easily identify what is causing a murmur and why, which is why echocardiogram is usually the next step.

Here's a description of systolic murmurs: https://en.wikipedia.org/wiki/Systolic_heart_murmur and here diastoic murmurs: https://en.wikipedia.org/wiki/Diastolic_heart_murmur Illustrates the many different murmurs.

 

[vitdoc]

A heart murmur is caused by non laminar flow of blood through an opening such as a heart valve. With normal human valves there generally is little turbulence and not much sound or murmur. Sometimes there is some sound even in normals and that is dubbed a physiological murmur. With an artificial valve there is generally some turbulence so there will be some murmur. However say in the case of an aortic valve the sound should be heard primarily in systole when the heart pumps the blood out and little murmur should be heard after the valve closes in diastole. If there is a swooshing sound after the valve closes then the valve may be leaking. The mitral valve may also leak but the leak would be heard in systole when the heart is pumping and the valve should be closed.
Again in the good old days listening to the heart was a big deal in trying to figure out what was going on. Physical diagnosis was taught and practiced I believe more than today since there was no echocardiography. Now with echo one can see much better what is going on with the valves. When I got my first aortic valve in 1977 it was probably one of the first tissue valves. The idea was that I was young and active. The longevity of the valve was not really known at the time. Five years into the valve I listened to myself one day and heard a new murmur that indicated the valve was not closing and was leaking. Shortly thereafter I got my first St. Jude mechanical in 1983. So wait for the echo to find out what is really going on. But physical diagnosis sometimes can be useful still.
The physician should have been more forthcoming with what he was concerned about and not left you hanging with worry.

 

[Paul1972]

A heart murmur is caused by non laminar flow of blood through an opening such as a heart valve. With normal human valves there generally is little turbulence and not much sound or murmur. Sometimes there is some sound even in normals and that is dubbed a physiological murmur. With an artificial valve there is generally some turbulence so there will be some murmur. However say in the case of an aortic valve the sound should be heard primarily in systole when the heart pumps the blood out and little murmur should be heard after the valve closes in diastole. If there is a swooshing sound after the valve closes then the valve may be leaking. The mitral valve may also leak but the leak would be heard in systole when the heart is pumping and the valve should be closed.
Again in the good old days listening to the heart was a big deal in trying to figure out what was going on. Physical diagnosis was taught and practiced I believe more than today since there was no echocardiography. Now with echo one can see much better what is going on with the valves. When I got my first aortic valve in 1977 it was probably one of the first tissue valves. The idea was that I was young and active. The longevity of the valve was not really known at the time. Five years into the valve I listened to myself one day and heard a new murmur that indicated the valve was not closing and was leaking. Shortly thereafter I got my first St. Jude mechanical in 1983. So wait for the echo to find out what is really going on. But physical diagnosis sometimes can be useful still.
The physician should have been more forthcoming with what he was concerned about and not left you hanging with worry.

Hi Vitdoc, thanks for the reply very informative The reason I posted about a murmur was that my report back from my last visit to my cardiologist was in writing which documented no murmur which was only six months ago. This time they listened to my chest and said there is a murmur and I need a echocardiogram, which made me wonder what if anything

 

[Paul1972]

Don’t know where the rest of my post went but thanks again vitdoc for your explanation. Best wishes Paul

 

[vitdoc]

Good luck with the echo.

 

[Paul1972]

Good luck with the echo.

Cheers vitdoc , I will ask if they can also give me a explanation for this sudden cross eyed sensation I get from time to time while I’m there

 

[Leah]

Cheers vitdoc , I will ask if they can also give me a explanation for this sudden cross eyed sensation I get from time to time while I’m there

 

[Leah]

I have had a murmur since my replacement 6 years ago. I also have a very small valve, but I’m pretty small framed, 120 lbs at time of surgery. I have an ATS open pivot. I’m having another echo next month because my cardio says my gradient has gone up a little bit. He said it might just stay the way it is. I hope so. I have horrible health anxiety and feel like I have PTSD from the surgery, which I’m sure a lot of us here do! Good luck with your echo!

 

[Paul1972]

I have had a murmur since my replacement 6 years ago. I also have a very small valve, but I’m pretty small framed, 120 lbs at time of surgery. I have an ATS open pivot. I’m having another echo next month because my cardio says my gradient has gone up a little bit. He said it might just stay the way it is. I hope so. I have horrible health anxiety and feel like I have PTSD from the surgery, which I’m sure a lot of us here do! Good luck with your echo! ❤

Hi Leah, I hope your echo goes well next month , i must admit I to have struggled at times with feeling anxious about everything, I suppose it’s only natural with what we as heart patients have gone through. Thanks for taking time to reply. Let us know how you got on with your echo. Best wishes Paul

 

[pellicle]

Cheers vitdoc , I will ask if they can also give me a explanation for this sudden cross eyed sensation I get from time to time while I’m there

Turning Japanese?

 

[Paul1972]

Turning Japanese?

I haven’t heard that song for years LOL

 

[pellicle]

Don’t know where the rest of my post went but thanks again vitdoc for your explanation. Best wishes Paul

it could be that you pressed preview at one stage instead of reply and somehow got tangled? (myself I find the button order and colour always leads me to make this mistake

Dunno, but if it happens again (and you notice it) try going back and "editing" because I've found it saves nicely your last entry.

 

[pellicle]

I haven’t heard that song for years LOL

figgad you'd know it (assumption that the 72 means your birth year), and like, "England".

;-)

 

[Paul1972]

figgad you'd know it (assumption that the 72 means your birth year), and like, "England".

;-)

you got it I see what you mean about wrong keys , must be my fat fingers!! Or I need a bigger iPhone

 

[ottagal]

This is not your case, but wanted to give another reason murmurs may be heard post AVR . In addition to a 'fixed' aortic valve, I have had mild-moderate pulmonary regurgitation/stenosis which has been monitored for years and so far nothing has had to be done. So, although my aortic valve is 'fixed', my cardiologist explained this is why they still hear a murmur.
As others said, an echocardiogram should give some answers. Wishing you all the best.

I like Pellicle's sage words of wisdom.

 

[Paul1972]

This is not your case, but wanted to give another reason murmurs may be heard post AVR . In addition to a 'fixed' aortic valve, I have had mild-moderate pulmonary regurgitation/stenosis which has been monitored for years and so far nothing has had to be done. So, although my aortic valve is 'fixed', my cardiologist explained this is why they still hear a murmur.
As others said, an echocardiogram should give some answers. Wishing you all the best.

I like Pellicle's sage words of wisdom.

Hi Ottagal , thanks for taking time out to reply , I’m sure the echo will explain everything. Best wishes Paul xx

 

[Duffey]

Hi Ottagal , thanks for taking time out to reply , I’m sure the echo will explain everything. Best wishes Paul xx

So when IS the echo? I think we’re all interested at this point!

 

[Paul1972]

So when IS the echo? I think we’re all interested at this point!

I only seen the surgeon 4 days ago Duffy, he said he will book me in for one, but being as it’s through the NHS and how busy they are I won’t know until I get a letter through the post