Heart Murmur in Adults: What It Means, When to Take It Seriously, and How It Is Evaluated

A heart murmur is an extra sound heard during a heart examination. In adults, a new heart murmur may be an early sign of heart valve disease, even in the absence of clear symptoms. This article explains what a heart murmur means, when it should be taken seriously, how it is evaluated with echocardiography, and which treatment options may be considered.

What Is a Heart Murmur?

When a doctor listens to your heart with a stethoscope, they hear the familiar heart sounds often described as “lub-dub.” These sounds are produced when the heart valves open and close as blood is pumped through the heart.

A heart murmur is an additional sound heard between the normal heartbeats. It may sound like a whooshing, blowing, or breathing noise. Many people become concerned when they are told that a murmur has been detected, but it is important to know that not all heart murmurs indicate disease. At the same time, a murmur in adults can be an important sign of underlying valve disease and should therefore be evaluated carefully.

What Does a Heart Murmur Mean?

A heart murmur occurs when blood flows more turbulently than normal through the heart. This may be caused by completely harmless conditions, especially in children and young adults. In adults, however, a murmur may indicate that one of the heart valves is not functioning properly.

It is important to understand that the loudness of a murmur does not reflect how serious the condition is. A loud murmur can be harmless, while severe valve disease may sometimes produce little or almost no audible sound. For this reason, a stethoscope is only the first step in evaluation and not a definitive diagnosis.

How Do the Heart Valves Work?

The heart has four valves that function like doors. They ensure that blood flows in the correct direction through the heart and out to the body. When blood needs to pass through, the valve opens fully and then closes tightly afterward.

When a valve does not function normally, one of two things usually occurs.

Regurgitation, also called insufficiency

The valve does not close properly, allowing blood to leak backward. This backward flow creates a murmur.

Stenosis, also called narrowing

The valve does not open fully, making the opening too narrow. The heart must then force blood through a restricted opening, which produces a murmur.

Both conditions increase the workload of the heart in order to maintain normal circulation.

Why Can Valve Disease Remain Hidden for a Long Time?

The heart is a highly adaptable organ. In valve disease, it may compensate by pumping harder or by changing its size and shape. As a result, many people can have significant valve disease for a long time without noticeable symptoms.

When symptoms finally appear, it often means that the heart has reached the limit of its ability to compensate. New symptoms and newly detected murmurs in adults are therefore important warning signs that should be taken seriously.

When Should a Heart Murmur Be Investigated Further?

A heart murmur should always be evaluated more closely in the following situations.

A new murmur in an adult

If you have never been told you had a murmur before and one is suddenly detected, it should be followed up, even if you otherwise feel well.

A murmur combined with symptoms

Symptoms of particular concern include:

• shortness of breath, especially during exertion or when lying flat

• reduced exercise capacity or unusual fatigue

• swelling of the legs

• dizziness or fainting

• chest pain or pressure

  
  

New symptoms in a previously healthy person

When someone without known heart disease develops a murmur and symptoms, valve disease should always be considered as a possible cause.

A Real-Life Example

A woman in her late 60s presented to an urgent care clinic with increasing shortness of breath over several weeks. She had no previous history of heart disease. The physician detected a clear heart murmur and referred her to the hospital.

Blood tests and an ECG showed signs of cardiac strain, but because she did not have typical symptoms of a heart attack, she was discharged with a planned echocardiogram several months later.

Two days later, she became acutely worse and was readmitted. An echocardiogram revealed severe leakage of a heart valve, and she required urgent surgery.

This case illustrates why the combination of a new heart murmur and shortness of breath in a previously healthy person should always be evaluated promptly.

The Most Common Valve Disorders

Aortic stenosis

Narrowing of the aortic valve is the most common valve disorder in older adults. Typical symptoms include shortness of breath during exertion, chest pain, and dizziness.

Mitral regurgitation

In this condition, blood leaks backward toward the lungs. It often causes shortness of breath, especially when lying down, and gradually reduced physical capacity.

Aortic regurgitation

The aortic valve does not close properly. This may cause shortness of breath, fatigue, and a sensation of strong or forceful heartbeats.

Mitral stenosis

Less common in Norway and in the western countries, but it can lead to significant shortness of breath and reduced exercise tolerance.

How Is Valve Disease Detected?

Stethoscope examination

Listening to the heart is often the first indication that something may be wrong. A murmur is a signal that should be interpreted in the proper clinical context.

Echocardiography

Echocardiography, or ultrasound of the heart, is the most important diagnostic test. It shows how the valves open and close, whether there is leakage or narrowing, and how the heart is affected. In adults with a new murmur, especially when symptoms are present, echocardiography should be performed promptly.

Blood tests

Blood tests such as NT-proBNP can indicate whether the heart is under strain and are used to support clinical assessment.

ECG

An ECG provides information about the electrical activity of the heart and may show signs of strain, but it cannot by itself diagnose valve disease.

How Common Is Severe Valve Disease?

Valve disease is not the most common cause of shortness of breath, but it is more frequent than many people realize, particularly in older adults. A significant proportion of patients evaluated for shortness of breath have moderate or severe valve disease. Many remain unaware of the condition until symptoms become apparent.

How Is Valve Disease Assessed?

Once valve disease has been identified, the patient is evaluated by a heart specialist. Treatment and follow-up are guided by international guidelines, including those from the European Society of Cardiology and the American Heart Association.

The assessment goes beyond the valve itself. The cardiologist considers factors such as:

• the presence of symptoms and their impact on daily life

• the heart’s pumping function

• whether the heart has begun to enlarge or weaken

• pressure conditions in the lungs

• blood tests indicating cardiac strain

• heart rhythm disturbances related to the valve disease

• age, other medical conditions, and expected benefit of treatment

  
  

Many patients are followed regularly over time. When valve disease becomes more advanced or when there is uncertainty about the timing or type of treatment, the case is discussed in a multidisciplinary heart team meeting. Cardiologists, cardiac surgeons, and sometimes other specialists participate to determine the best approach for the individual patient.

How Is Valve Disease Treated?

Treatment is generally divided into three main categories.

Follow-up and medical therapy

Many patients with mild to moderate valve disease require only regular monitoring. Medications can relieve symptoms and reduce the workload on the heart, but they do not repair the valve itself.

Surgery

In severe valve disease, surgery is often necessary. The valve may be repaired, which is often preferred in cases of regurgitation, or replaced with an artificial valve. A key goal today is to intervene before permanent damage to the heart occurs.

Catheter-based treatment

In narrowing of the aortic valve, a new valve can often be implanted through a thin catheter inserted via the groin, without opening the chest. This procedure is known as TAVI and is now an equivalent alternative to open surgery for many patients.

The choice of treatment is individualized and often made after discussion in a heart team meeting.

Why Is Timing So Important?

In valve disease, the question is not only whether treatment is needed, but when. Delaying treatment too long can lead to permanent heart damage, even if the valve is later repaired or replaced. For this reason, many patients are closely monitored as they approach the threshold for intervention.

Key Points to Remember

• A new heart murmur in adults should always be evaluated

• A murmur combined with symptoms requires prompt assessment

• Not all murmurs are dangerous, but new murmurs must be taken seriously

• Echocardiography is the most important diagnostic test

• With appropriate follow-up and treatment, prognosis is often good

  
  

Early detection and proper evaluation are essential. Do not hesitate to ask questions or seek a second opinion if you are concerned.

Frequently Asked Questions About Heart Murmurs

What is a heart murmur?

A heart murmur is an extra sound heard when a doctor listens to the heart with a stethoscope. The sound is caused by turbulent blood flow through the heart. A murmur can be completely harmless, but it can also be a sign of underlying heart valve disease.

Are heart murmurs dangerous?

Not always. Many heart murmurs are harmless, especially in children and young adults. In adults, however, a new heart murmur should be evaluated further, particularly if it occurs together with symptoms such as shortness of breath, fatigue, dizziness, or chest discomfort.

What causes a heart murmur?

The most common causes are heart valve conditions, either narrowing of a valve (stenosis) or leakage of a valve (regurgitation). Murmurs can also occur in situations with increased blood flow, such as fever, anemia, pregnancy, or physical stress, and may then be benign.

What is the difference between a heart murmur and valve disease?

A heart murmur is a physical finding, meaning a sound heard during examination. Heart valve disease is a diagnosis that is confirmed by further testing, usually with echocardiography. Not all heart murmurs indicate valve disease.

Can you have severe valve disease without symptoms?

Yes. The heart can compensate for valve disease for a long time. Many people have few or no symptoms in the early stages. Symptoms often appear later, when the heart is approaching the limits of its ability to compensate.

When should a heart murmur be evaluated further?

Further evaluation is recommended if the murmur is new in an adult, if it occurs together with symptoms, or if there is known heart disease. In these situations, echocardiography is usually indicated.

How is a heart murmur evaluated?

The most important test is echocardiography, which provides detailed information about valve function and how the heart is affected. An ECG and blood tests, such as NT-proBNP, may also be used to support the clinical assessment.

What is echocardiography?

Echocardiography is an ultrasound examination of the heart. It is painless and noninvasive. The test shows how the heart valves open and close, whether there is narrowing or leakage, and how the heart muscle is functioning.

Can a heart murmur go away?

Yes. Harmless murmurs can come and go, especially in younger individuals. Murmurs caused by valve disease usually persist, but they may remain stable for long periods and only require regular monitoring.

Does everyone with valve disease need treatment?

No. Many people with mild to moderate valve disease only need regular follow-up. Treatment is usually considered when the disease becomes severe, causes symptoms, or begins to affect heart function.

What treatment options exist for valve disease?

Treatment generally falls into three categories: regular follow-up with or without medication, surgical valve repair or replacement, and catheter-based procedures such as TAVI for aortic stenosis. The most appropriate option is determined individually.

What is a Heart Team meeting?

A Heart Team meeting is a multidisciplinary discussion involving cardiologists, cardiac surgeons, and imaging specialists. These meetings are used to decide the best treatment strategy and timing for an individual patient, especially when decisions are complex.

When should I seek medical care urgently?

You should seek medical care if you experience new or worsening shortness of breath, shortness of breath when lying flat, unexplained fatigue, dizziness or fainting, leg swelling, or chest pain or pressure. This is particularly important if a heart murmur or valve disease has already been identified.

What is the outlook for valve disease?

With appropriate follow-up and timely treatment, the outlook for heart valve disease is often good. Modern surgical and catheter-based treatments can provide excellent results, especially when intervention occurs before permanent heart damage develops.