Intermittent murmur

[anigail82]

I am 25 and have a hx of orthostatic hypotension.  I recently, while playing with my stethoscope, noticed a heart murmur at the left upper sternal border.  I know this sounds paranoid.  Recently after discovering this, I had an appointment to see my doctor and I brought it up.  He heard nothing and I felt crazy for mentioning it.

Since then, I've been paying more attention, and it seems to come and go.  I can bring it on by getting up and walking across the house.  My boyfriend has heard it too, so I'm not crazy.

I'm young and relatively healthy, so I'm assuming this is nothing exciting.  Could this just be caused by my occasional hypotension?  I have a lot of difficulty exercising due to feeling light-headed and becoming tachycardic (170-180) even with light exercise.  I'm worried about the safety of exercising if there's something wrong with my heart.  Should I be concerned, or could this just be a functional murmur with nothing to worry about?

[jmccp9]

I can concur with the previous comment.  No physician has ever heard my murmur unless I start exercising or get my heart pumping faster.  I am 50 years old and have had a very clear heart murmur (loud swishing sound after initial thump) since being a teenager.  I used to get nervous about it and went to the doctor a lot.  I even went to a Cardiologist and they did an echocariogram and after listening and evaluating all of it characterized it as a "flow murmur" that only occurred when exerting myself in exercise to get my heart pumping hard.  I have since run 5 marathons, including Boston two weeks ago.  I train very hard and have understood the flow murmur to be a byproduct of a normal healthy heart pushing blood rather than a problem.  I cannot speak to other people's situation, but this was what I have gone through and found out and thought I'd share it.

[markmsn10]

First off - the most common finding of a benign (innocent) murmur is increase in intensity during physical excertion.  This has to do with the increased stroke volume as a natural response.   You are hearing the blood across a normal heart valve.   As many as 50% of the population can have these murmurs and are nothing to be worried about.   I've also had the same murmur upper-left.   I've also listened to it myself and notice a few things which may help.   Under resting conditions I can barely hear it (if at all)   with even a tiny amount (like getting up and moving about) I can hear it about a 1/6 to 2/6.   I can also hear it at or just below the apex (it is the same murmur as the shape/intensity is the same)  it also gets quieter in that location as does it in the upper left border.  

There isn't any radiation to the carotid arteries nor further down in other locations.  Just upper left and "more muffled" below the apex.   I can sometimes hear an increase in intensity with inspiration (breathing through my mouth with deep inspiration) and appears to radiate towards the left along the pulmonary artery.

I had an echocardiogram done a few times (last time in 2002) and found increased flow across my pulmonary valve but no disease.   So basically it was nothing to worry about.

[anigail82]

It's a systolic murmur, maybe 2/6 at loudest, and is loudest at the lower left sternal border.  Again, I have orthostatic hypotension, and I can occasionally bring on the murmur if i stand up quickly or walk quickly across the room, so I feel it is likely related to a decreased blood return to the heart when I get my usual hypotensive episodes.  

I'm young still, so I don't feel like I should have any serious heart problems.  But I worry cuz I always have had palpitations and exercise intolerance due to my orthostatic hypotension.  I'm just hoping I haven't managed to actually damage my heart.

[ed34]

Thank goodness you are in the medical profession. I was having images of the worlds population walking around with stethoscopes. What a mess that would be, Doctors surgeries would have queues miles long with people wanting to know what certain noises are. Such devices are best left to the experts.
If you can hear a murmur then the best choice would be to see a cardiologist. When you do hear the murmur, what is your heart rate? blood pressure? compared to when you cannot hear it? What cycle is the murmur, diastolic or systolic?

[Smiley2000]

Hi there,

I think it is very good that you are monitoring your own health, with the tools at your disposal.  I wish I had my own stethoscope :)

I have mitral valve disease and had a repair done in 2008.  It is very cool to see your heart and valves function on an Echocardiogram.  Even more so during a T.E.E.

Heart murmers can come and go as your heart does not pump the same volume of blood every time.  Floppy valves are very common and benign findings in a healthy person.

All the best with your studies and future :)

[anigail82]

I am a paranoid med student.  But I know a murmur when I hear one.  I'm not so horribly concerned; more curious.

[ed34]

Are you a medical professional? I'm just wondering why you are using a stethoscope unless trained to know what to listen for, and exactly where to place it. Most heart murmurs are harmless. I can't imagine a heart murmur coming and going, murmurs are usually due to valve problems and will remain.
If your Doctor has listened, and hears no abnormalities, I would go with that.