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The differences between a dangerous and harmless heart murmur


In 2018, cardiologist John Ryan, MD was reading an echocardiogram when a set of notes jumped out at him. It wasn’t so much the issue identified by the graphic measuring a heart’s beating, it was who had ordered it: a rheumatologist, who specializes in arthritis, autoimmune diseases, and pain disorders affecting joints.

According to the notes, the rheumatologist had detected a heart murmur and asked the patient if he had one. The 40-year-old male said no. “I hear one now,” the rheumatologist said.

Skeptical of a joint specialist catching a heart murmur, Ryan was surprised by what he found. “This fellow had a thickened heart, which put him at immediate risk of sudden death,” Ryan recalls. After telling the patient the condition was hypertrophic cardiomyopathy, Ryan called the rheumatologist to compliment her on a good catch.

Heart murmurs are deceptive issues in cardiology. Sometimes they’re nothing to worry about. “If you do an ultrasound and find that there is no problem with heart valves or no obstruction, that’s called ‘an innocent murmur,’” Ryan explains. “It does not cause damage, but it’s worth knowing.” Other times, murmurs can signal serious cardiac problems — even life-threatening ones.

The significance is whether the murmur — what Ryan calls “turbulent blood flow within the heart” — is new or not. In some cases, patients are born with a heart murmur or develop it at a young age. Sometimes it’s the result of an uneven amount of blood going backward, called regurgitation. Other times it’s because of a narrowing valve. And yet for other patients, they go through many physicals and primary care visits until, out of the blue, a provider notes that she hears a heart murmur during a routine check-up.

Underlying damage is a concern if heart valve problems exist. Symptoms can include shortness of breath or starting to retain fluid. A leaky or narrowed valve —examples of valvular disease — or a heart beating so quickly it impedes blood flow can all require surgery.

“If valvular heart disease causes heart failure, the treatment is to replace or repair the valve,” Ryan says. That can mean open-heart surgery.

That’s an operation TJ Thompson has survived four times. His cardiovascular journey began when a doctor identified his heart murmur at just 5 years old. Now 42, the property manager for a self-storage company was diagnosed with aortic stenosis. One of the leaflets in his heart doesn’t open properly. He’s subsequently had four open-heart surgeries, with a series of valves, both porcine and mechanical, implanted.


Despite such issues, in his early 20s, Thompson took up running as a hobby. At the time, his heart relied on a surgically implanted pig valve to work. When he turned 36, rather than the heart murmur alerting him to problems, other conditions appeared. “I was trying to warm up for a run and I couldn’t catch my breath,” Thompson says. “My ankles and legs were swelling up.” His pig valve, doctors discovered, had broken apart.

Six years after his last surgery, Thompson is back to running marathons — with a pronounced heart murmur. Ryan told him that he would always have it, and that’s okay.

If there’s one thing Thompson has learned from having a heart murmur and a problematic valve, it’s that the fundamentals of his heart are solid. “Despite the heart valve, I actually have a very strong heart,” he says.

The good news in all of this is that despite the potential variety of diagnoses, determining a murmur’s “innocence” isn’t an invasive or traumatic experience. Echocardiograms “are so straightforward,” Ryan says. “There’s no radiation, no stress, and no trauma. No damage can come from it.”