I am a 26-year-old female. I had a routine pap smear done recently and my gynecologist said it sounded like I have a “functional heart murmur”. She said that she couldn’t hear it when I sat up straight, only when I lay down. She also said there is no cause for alarm, and that many people with heart murmurs live long, healthy lives. I think that I am healthy, although maybe a little underweight. I’m 5 feet 6 inches and weigh 106 pounds, but am very petite. I run about 12 to 15 miles per week and eat healthy and take vitamins.
Should I be concerned about this? Could this lead to heart problems for me in the future? What exactly is a “functional heart murmur”? What is the cause of this and should I do anything special? I have run for many years and this has never affected me before. My grandfather and grandmother on my mother’s side both passed away from heart failure, although at a late age, and my father’s mother supposedly had a heart murmur, but she lived until she was 88!
Heart murmurs are noises that a doctor may hear when examining someone’s heart. They may be indicative of a cardiac problem but are often not significant, in which case they are usually called functional. Back in the days when rheumatic fever was common and many people developed rheumatic heart disease, we often heard the typical murmurs of that condition. Congenital heart diseases, mitral valve prolapse, cardiomyopathies, and infections on the heart valves can also all cause different kinds of heart murmurs, but would be unlikely in a person like today’s writer who has no symptoms, and whose murmur was heard during the course of a routine examination.
The heart has four chambers, two atria on top, and two ventricles below. They are referred to as the left atrium and left ventricle or the right atrium and right ventricle. On each side there is a valve between the atrium and the ventricle, and on each side there is a valve between the ventricle and the artery taking blood away from the heart.
Murmurs arise from turbulence in the flow of blood into or out of the heart chambers, and are usually related to one of the valves which is producing the turbulence. Thus there is a particular murmur associated with stenosis (narrowing) of the mitral valve between the left atrium and the left ventricle, and a different murmur produced by aortic stenosis, in which the valve between the left ventricle and the artery leading from it, the aorta, is narrowed. When a person has a murmur that is not due to any abnormal change in the heart or one of the valves, it is said to be a functional murmur. They are usually not loud, always occur in systole, and often change when the person changes position.
Murmurs are graded from I to VI according to their loudness. Doctors also listen to see if the murmur is occurring during systole, when the heart is contracting, or during diastole, when the heart is relaxing and filling again with blood. Changes in the intensity of the murmur when it occurs, often referred to as the shape of the murmur, are also noted.
The most common type of heart disease in this country is coronary artery disease (CAD); it can lead to heart attacks but usually does not cause any murmurs. Similarly, heart failure seldom produces a murmur unless it is due to a damaged valve — as in rheumatic heart disease or severe mitral valve prolapse.
There are so many different kinds of congenital heart disease that I can’t describe all the murmurs that might develop, but generally speaking severe congenital heart disease causes symptoms which would have been recognized by today’s writer or her doctor.
Hypertrophic cardiomyopathy can produce a murmur, and is somewhat worrisome in that it can occur in young people, and can occasionally cause sudden death in athletes. However, there is often a family history of the disease, and the murmur which it produces is usually described as harsh and diamond shaped. I doubt very much that her doctor would mistake that murmur for a functional one. Shortness of breath is a common symptom.
Being thin increases the likelihood that a doctor will hear a murmur in someone since there is simply less bone, muscle and fat between the heart and the doctor’s stethoscope. Therefore, soft functional murmurs which would never be heard at all in a heavier person may show up on an exam in a thin person.
If a doctor has any question about a murmur that she hears, the next step is to order an echocardiogram, a non-invasive test that is very accurate in determining if there are any structural problems causing it.