Transcription:

Scott Webb: Welcome to Check-up Chat with EvergreenHealth. I'm Scott Webb. And when your provider grabs a stethoscope and listens to your heart, they're checking for a very distinct rhythm, but sometimes they may also hear a swishing sound along with the heartbeat. And that could be the sign of a heart murmur. A common diagnosis, typically heart murmurs do not have a significant impact on your overall health, but we're here with Dr. Oscar Gonzalez, physician at EvergreenHealth Heart Care. And Dr. Gonzales is going to help us break this down and understand what a heart murmur is, how it's diagnosed and so on.

So Dr. Gonzalez, so great to have your time today. I think we've all wondered, you know, when a doctor's listening to our hearts with a stethoscope, what exactly you're listening for, right? So it's great to have you on, great to have your expertise. And today, we're going to talk about heart murmurs. So let's do that. What is a heart murmur and how are they caused?

Dr. Oscar Gonzalez: A heart murmur really is just describing the sound of blood. And sometimes it could be good, sometimes it's bad. If you think about your heart, it's a very simple pump. Its purpose is to push blood throughout your body after it collects oxygen and nutrients, and just really transfers it to all of the vital organs. And the inside of the heart and all the arteries are typically smooth and so blood has a particular characteristic when you listen to it. Usually, it's quiet. In some people that are thin or have a very vigorous heartbeat, you'll be able to hear the natural flow of blood, but typically it's quiet. And so when you describe a murmur, you're describing the sound of blood, and that can vary depending on how it sounds, where it's going, the characteristics and so forth.

Scott Webb: Yeah. And good to set the stage there, because I've often wondered, you know, because they want you to kind of be still, but breathe and doctors don't like to be distracted while they're listening and I can kind of understand why, because you're listening for the very distinct things or distinct rhythms or a swishing, whatever it might be. So who typically gets diagnosed with heart murmurs? And is it something you're born with or is it more something that we sort of develop over time?

Dr. Oscar Gonzalez: You're sort of describing two scenarios. And unfortunately, A lot of heart murmurs are discovered by accident as with many heart conditions. A lot of heart disease is actually silent until it becomes a problem, but an astute clinician will actually listen for a murmur after they've gathered some history from you. If you notice your visit typically starts with questions and maybe you came in with a complaint, maybe you didn't and maybe it's just a routine physical. And as your physician is asking questions, they bring out something that may actually prompt them to listen for something in your heart. So it's not a passive exam. It's actually you're looking for something. And if it's a routine physical, you're there for other reasons, it maybe discovered by accident or incidental.

Scott Webb: So, how do we know then? Or how do you know as an expert, what's normal and what's abnormal? Is that unique to the person or is there sort of a general way of viewing this?

Dr. Oscar Gonzalez: There's actually two ways to look at this. Number one, as I said, if it relates to the exam and the history that the patient is describing, then, you know, you're certainly concerned about particular murmurs. Age is important because if you hear a murmur in someone that's, let's say, less than 18 years of age versus someone that's greater than 90 years of age, that should prompt the provider to think of different things.

Murmurs can be benign, as I said. Sometimes it just indicates that rigorous blood flow. Perhaps your thyroid is elevated. Perhaps you're nervous and your adrenaline is pumping your heart. Like I said, sometimes if you're thin, you could hear more heart sounds. But if it has a particular sound, especially in the timing of the cycle And it's going in a certain direction, then that prompts concerns for the provider and further investigation and sometimes a referral for more diagnostic exams, or perhaps a consultation with a cardiologist like myself.

Scott Webb: Yeah, you can kind of get a sense of when it would be indicated. And, you know, it's one of these things where, I'm guessing anyway, that if it's more often than not diagnosed accidentally or incidentally, then does that stand to reason that we don't really have any symptoms? Like do people know that they have a heart murmur?

Dr. Oscar Gonzalez: The symptoms in most cases can be very subtle, like shortness of breath, for instance. If you notice that you're starting to get short of breath with particular exercises or exertions that didn't cause you to get short of breath, then that actually it may be a potential symptom of a murmur. But that's a very vague symptom because shortness of breath can happen even if you don't exercise for a while and you get deconditioned. And so, you know, when you get shortness of breath and the examiner listened to your heart and there's a murmur that raises concern, then perhaps that murmur is causing your shortness of breath. And murmurs can be from valves that are either leaking or narrowing, and they may need to be surgically repaired.

Scott Webb: Yeah. And you can kind of see how, as you say, if you haven't worked out in a while, then it might be expected to be perhaps a little short of breath or more short of breath than you normally would be. So it doesn't necessarily mean that you have something wrong with your heart or that you immediately should be checked for a heart murmur. But I'm sure that's just sort of the tricky part of medicine is that folks experience things and they're not sure, and that's why we have doctors and we do the patient history and examination and all of that. And I kind of prefaced by saying that a heart murmur doesn't necessarily mean anything to some folks, right? That they can be diagnosed, be treated, they can live with it. So what would be your advice to someone who's been recently diagnosed with a heart murmur, the next steps, how best to live with a heart murmur and so on?

Dr. Oscar Gonzalez: I'll give you my long-winded answer. The art of medicine has really changed. And you know, back when I was in training several decades ago now, I actually trained with some various astute clinicians and they were very good at clinical exam. And that art form has really been lost over time. In part because we just don't do it as well. I mean, there's been several studies to look at how well do clinicians overall diagnose murmurs correctly. And, if there is a murmur and it's loud, I think loudness really is probably a general way to think about a murmur, loud or soft, then loud typically doesn't mean that it's benign actually. Loud typically means that it needs further investigation. A lot of the times that's going to lead to a diagnostic exam called an echocardiogram, and an echocardiogram allows you to visualize where the murmur is coming from and actually see the pathology and therefore plan what the next steps are. And that may just be monitoring over time to see if that murmur changes or it may mean that you need corrective actions.

Scott Webb: Yeah, really interesting what you're saying about how medicine changes. As we wrap up here, what would be your final thoughts and takeaways on heart murmurs?

Dr. Oscar Gonzalez: Well, if your provider listens to a heart murmur and they are concerned, I would definitely follow up with your local cardiologist and that may prompt additional examinations. And best case scenario, that murmur is benign and it just means that, you know, heart's working very vigorously. But I think murmurs should not be ignored and that definitely should require additional testing if there's concern by the examiner.

Scott Webb: Yeah, definitely. And just a great advice from an expert today. Thank you so much for your time and you stay well.

Dr. Oscar Gonzalez: All right. Thank you very much.

Scott Webb: EvergreenHealth Heart Care offers clinically sophisticated diagnostic treatment and rehabilitation for heart disease and heart attack. To learn more and make an appointment for a heart care specialist, please visit evergreenhealth.com/heart.

And that wraps up this episode of Check-Up Chat with EvergreenHealth. Head on over to our website at evergreenhealth.com for more information and to get connected with one of our providers.

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