Heart Murmurs: What They Mean, When They're Harmless, and How They're Treated
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
A heart murmur is a whooshing or swishing sound made by turbulent blood flow, heard with a stethoscope [1]. Many murmurs — especially in children — are innocent, mean there is no heart disease, and need no treatment. Others point to valve problems or congenital heart defects and require tests such as an echocardiogram. Treatment depends entirely on the cause, ranging from no treatment at all to medications and valve surgery [2].
Quick Answer
A heart murmur is a whooshing or swishing sound made by rapid, turbulent blood flow through the heart. Most murmurs, especially in children, are innocent: they are not a sign of heart disease and need no treatment. Innocent murmurs can be caused by fever, anemia, an overactive thyroid, rapid growth, exercise, or pregnancy, and often fade with time. Worrisome murmurs signal underlying problems such as heart valve disease or congenital heart defects and require evaluation. Diagnosis is driven by the echocardiogram, the main test for finding the cause, and treatment — from no treatment to medications or valve surgery — depends on what is found.
Key point: An innocent heart murmur is not a sign of heart disease and does not need treatment, but a worrisome murmur needs proper testing to find the cause.
What the research says
Many newborns with a murmur have a congenital heart defect. A systematic review found that murmurs were detected in 0.6% to 8.6% of newborns. Among 1,928 newborns with asymptomatic murmurs, 37.3% had a congenital heart defect on echocardiogram; ventricular septal defect was the most common, more than half of the cases were moderate and needed outpatient cardiology follow-up, and 2.5% were severe enough to need immediate intervention (Yoon et al., BMC Pediatr, 2020 [3]).
In school-age children, a murmur can point to rheumatic heart disease. Among 4,436 schoolchildren screened in Tanzania, where rheumatic heart disease is common, 1.2% had a murmur and 2.1% had sub-clinical rheumatic heart disease. Having a murmur was associated with about 5.6 times higher odds of sub-clinical rheumatic heart disease (adjusted OR 5.63; 95% CI 2.31 to 13.69) (Chillo et al., BMC Cardiovasc Disord, 2023 [4]).
Listening alone is not enough to find valve disease in older adults. In 251 adults over 65 with no symptoms, echocardiography found new valve disease in 68% (mild) and 14% (significant). Auscultation by experienced family doctors detected only 32% of mild and 44% of significant cases, with specificity of 67% and 69%. The authors concluded that echocardiography is the better strategy when symptoms suggest valve disease (Gardezi et al., Heart, 2018 [5]).
What Is a Heart Murmur?
A heart murmur is a sound made by rapid, choppy (turbulent) blood flow through the heart. These sounds — often described as whooshing or swishing — can be heard with a device called a stethoscope during a physical exam.
A typical heartbeat makes two sounds, like "lubb-dupp" (sometimes described as "lub-DUP"), when the heart valves are closing. A murmur is the extra noise that turbulence adds on top of that normal beat.
Heart murmurs fall into two broad timing groups. They can be present at birth (congenital) or develop later in life (acquired). Some murmurs are harmless (innocent), while others may be a sign of a serious heart condition that needs testing to check the heart and heart valves.
Murmur category | What it means |
Innocent (harmless) | Not a sign of heart disease; the heart is usually normal; no treatment needed |
Worrisome | May signal a serious heart condition; tests are needed to check the heart and valves |
Congenital | Present at birth, often from a structural heart defect |
Acquired | Develops later in life, often from heart valve problems |
What Does a Heart Murmur Feel Like? Symptoms to Watch For
Harmless (innocent) heart murmurs usually don't cause any other symptoms. That is why they are often found by accident during a routine checkup.
Symptoms of worrisome heart murmurs depend on the cause. The extra heart sounds themselves are what providers hear — what patients notice are the signs of the underlying problem.
Symptom | What it looks like |
Skin and lip color | Blue or gray fingernails or lips |
Chest | Chest pain |
Breathing | Shortness of breath; a cough that doesn't go away |
Head | Dizziness; fainting |
Sweating | Heavy sweating with little or no activity |
Fluid buildup | Swelling or sudden weight gain; swollen liver; swollen neck veins |
In infants | Poor appetite and lack of growth |
If you notice any of these symptoms alongside a murmur, they are worth discussing with a healthcare provider.
When Should You See a Doctor?
Most heart murmurs aren't serious. If you're concerned about a heart murmur, make an appointment to see your primary care provider. Your provider can tell you if follow-up care is needed.
Get prompt medical attention if a murmur comes with warning signs such as chest pain, fainting, bluish skin, or unexplained shortness of breath.
What Causes a Heart Murmur?
A heart murmur is caused by rapid, choppy (turbulent) blood flow through the heart. The turbulence can happen at different points in the heartbeat, and the timing actually helps doctors judge how serious the murmur is.
Timing | What's happening | What it usually means |
Diastolic murmur | Occurs when the heart is filling with blood | May signal a heart problem |
Systolic murmur | Occurs when the heart is emptying | Generally an innocent murmur |
Continuous murmur | Occurs throughout the heartbeat | May signal a heart problem |
Innocent (harmless) heart murmurs
A person with an innocent murmur usually has a typical heart. Innocent heart murmurs are common in newborns and children.
Several everyday conditions can change blood flow enough to cause an innocent murmur. These include fever, anemia (a lack of healthy red blood cells that carry oxygen to body tissues), an overactive thyroid (hyperthyroidism), phases of rapid growth such as adolescence, physical activity or exercise, and pregnancy.
Innocent heart murmurs may go away over time. Sometimes heart murmurs continue for life without causing serious health problems.
Worrisome heart murmurs
In children, worrisome murmurs are usually due to a problem with the heart's structure that's present at birth (congenital heart defect).
Congenital cause | What it is |
Holes in the heart | A hole may form before birth in the wall between the upper or lower heart chambers, or both; examples are atrial septal defect and ventricular septal defect |
Cardiac shunts | A congenital defect causes irregular blood flow between the heart chambers or blood vessels |
In adults, worrisome heart murmurs are usually due to heart valve problems that develop later in life (acquired heart valve disease).
Acquired cause | How it creates a murmur |
Calcium deposits | Calcium can make a valve — such as the mitral or aortic valve — stiff and narrow (valve stenosis). A calcified valve also may not close completely, letting blood flow backward. The changes in blood flow create a murmur. This is called calcific or degenerative valve disease. |
Endocarditis | Infection of the inner heart lining and valves, caused by bacteria or other germs that spread through the blood from another part of the body, such as the mouth. A murmur may occur if the infection is untreated and affects the heart valves. |
Rheumatic fever | A serious complication of strep throat, rare in the United States. It may occur in those who don't get or complete treatment for strep throat. When it affects the valves, it's called rheumatic heart disease and can cause a murmur. |
Who Is More Likely to Have a Heart Murmur?
Several factors raise the chance of heart murmurs in babies, and a long list of medical conditions can increase risk at any age.
Risk factors in babies include a family history of heart problems linked to murmurs, uncontrolled diabetes in the mother during pregnancy, German measles (rubella) in the mother during pregnancy, and the mother's use of certain medications, alcohol, or illegal drugs during pregnancy.
Risk factor | Why it matters |
Family history of heart problems linked to murmurs | Inherited structural heart issues can run in families |
Mother's uncontrolled diabetes during pregnancy | Raises the chance of structural heart defects in the baby |
Rubella (German measles) in the mother during pregnancy | Infection during pregnancy can affect the baby's heart |
Certain medications, alcohol, or illegal drugs during pregnancy | Can interfere with the baby's heart development |
Medical conditions that increase heart murmur risk include a rare cancerous tumor that releases certain chemicals into the bloodstream (carcinoid syndrome), a weakened heart muscle (cardiomyopathy), an infection of the lining of the heart (endocarditis), anemia, blood disorders marked by a high number of white cells called eosinophils (hypereosinophilic syndrome), certain autoimmune disorders such as lupus and rheumatoid arthritis, heart valve disease, high blood pressure in the lungs (pulmonary hypertension), a history of rheumatic fever, and an overactive thyroid (hyperthyroidism).
Can Heart Murmurs Be Prevented?
There's no known prevention for heart murmurs. But healthy lifestyle changes can improve heart health and prevent some conditions linked to murmurs in adults. Many childhood heart murmurs go away on their own as children grow.
How Heart Murmurs Are Diagnosed
Heart murmurs are often detected when a physical exam is done for another reason. Your healthcare provider will ask questions about your personal and family medical history.
A provider listens to the heart with a stethoscope and considers several features when deciding whether a murmur is innocent or worrisome.
What the provider checks | The question it answers |
Volume | How loud is the murmur on a scale from 1 to 6? The loudest is 6 |
Location | Where in the heart is it? Does the sound spread to the neck or back? |
Pitch | Is it high-, medium-, or low-pitched? |
Timing | Systolic murmurs generally are innocent; diastolic or continuous murmurs may signal a heart problem |
Sound changes | Does exercising or changing body position affect the sound? |
Tests
Tests are done to determine the cause of worrisome heart murmurs.
Echocardiogram. This is the main test used to determine the cause of a heart murmur. It uses sound waves to create pictures of the beating heart and shows how blood flows through the heart and heart valves.
Chest X-ray. A chest X-ray is a picture of the heart and lungs. It can tell whether the heart is enlarged, and heart enlargement may cause some heart murmurs.
Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sensors (electrodes) are attached to the chest and sometimes to the arms or legs, and wires connect to a machine that prints or displays results. A provider can look at the signal patterns for signs of heart problems.
Cardiac catheterization. This test may be done when other tests haven't found a cause for the murmur. A cardiologist inserts a flexible tube (catheter) into a blood vessel, usually in the groin or wrist, and gently guides it to the heart. Dye may be injected through the catheter so blood vessels show up better on the images made during the test.
Treatment Options
Innocent heart murmurs don't usually need treatment. If a fever or an overactive thyroid causes a murmur, the murmur usually goes away once that condition is treated.
Treatment for a worrisome heart murmur depends on the cause. A worrisome murmur requires close monitoring by a healthcare provider, and medications or surgery may be needed.
Treatment type | What it involves |
No treatment | Innocent murmurs usually need no treatment |
Treat the cause | If fever or hyperthyroidism causes the murmur, it usually goes away once the condition is treated |
Medications | Blood thinners, diuretics, ACE inhibitors, beta blockers; antibiotics only in specific situations |
Surgery or procedures | Heart valve repair or replacement, using open-heart, minimally invasive, robotic, or catheter approaches |
Medications
Several types of medication are used to treat heart conditions associated with murmurs.
Blood thinners (anticoagulants) prevent blood clots. Some conditions that cause murmurs are closely linked to irregular heartbeats (arrhythmias) that can cause blood clots, which raise stroke risk. Options include warfarin (Jantoven), clopidogrel (Plavix), apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), and others.
Water pills (diuretics) remove excess fluid from the body. A diuretic may be given to treat high blood pressure or other conditions that can make heart murmurs worse.
ACE inhibitors lower blood pressure. High blood pressure can worsen the underlying conditions that cause murmurs.
Beta blockers lower heart rate and blood pressure.
Antibiotics. In the past, many people with worrisome murmurs were told to take antibiotics before surgery or dental procedures to prevent certain heart infections. That recommendation has changed. Antibiotics are now only recommended in specific situations — for instance, for people with artificial heart valves, a history of heart valve infections, or congenital heart defects that increase the risk of infection inside the heart.
Surgery or other procedures
Surgery may be needed to correct a condition that causes a worrisome murmur. If a narrowed or leaky heart valve is causing the murmur and other symptoms, heart valve repair or replacement may be needed.
During heart valve repair, a surgeon might patch holes in a valve, separate valve leaflets that have fused, replace the cords that support the valve, remove excess valve tissue so the valve can close tightly, or tighten or reinforce the ring around a valve.
Surgical approach | What it means |
Open-heart surgery | The chest is opened to reach the heart directly |
Minimally invasive heart surgery | Smaller incisions are used to reach the heart |
Robotic heart surgery | Surgeons operate using robotic instruments |
Catheter procedure | Uses flexible tubes guided through blood vessels, no large incision |
The way the surgery or procedure is done depends on the specific heart condition.
Preparing for Your Appointment
If you're concerned about a heart murmur, make an appointment to see your family care provider. Although most heart murmurs are harmless, it's a good idea to check for any underlying heart problems that could be serious. You may be referred to a doctor who specializes in heart diseases (a cardiologist).
Appointments can be brief, so preparation helps. Be aware of any pre-appointment restrictions, such as avoiding food or drink for several hours before a certain type of echocardiogram. Write down any symptoms, including ones that may seem unrelated to heart murmurs. Write down your family medical history, including a family history of heart murmurs, heart rhythm problems, heart defects, coronary artery disease, genetic disorders, stroke, high blood pressure, or diabetes. Bring a list of all current medications, vitamins, and supplements with dosages, and take a family member or friend along if possible.
Some useful questions to ask your provider include: What's the most likely cause of the murmur? What kinds of tests are necessary? What is the best treatment or follow-up care? Are there dietary or exercise restrictions? Should I see a specialist? Is there a generic alternative to the prescribed medicine?
Expect your provider to ask about your symptoms, including any history of fainting, chest pain, leg swelling, skin color changes, and shortness of breath — as well as when symptoms started, whether they come and go, how severe they are, and any family history of heart murmurs or heart valve problems.
Conclusion: Most Murmurs Are Noise — Some Are Messages
Heart murmurs are common and mostly harmless. When the heart is normal, the whooshing sound usually needs nothing more than awareness. But the same sound can also be the first clue to a valve problem, a congenital defect, or an infection — and those causes deserve proper testing and, when needed, treatment.
The deciding factor is evaluation. An echocardiogram can show whether the murmur is innocent or a message worth acting on. If you or your child has a murmur with chest pain, fainting, bluish skin, or unexplained breathlessness, schedule a heart evaluation without delay. Our guides to heart valve disease and congenital heart conditions can help you understand the bigger picture of cardiovascular health.
Frequently Asked Questions
What is a heart murmur?
A heart murmur is a whooshing or swishing sound made by rapid, turbulent blood flow through the heart. It can be heard with a stethoscope and can be harmless (innocent) or a sign of an underlying heart problem.
Is a heart murmur always a sign of heart disease?
No. Innocent heart murmurs are not a sign of heart disease and don't need treatment. Worrisome murmurs may indicate heart valve disease or congenital heart defects and require testing.
What causes an innocent heart murmur?
Things that change blood flow — fever, anemia, hyperthyroidism, rapid growth phases like adolescence, exercise, and pregnancy — can cause innocent murmurs. They are common in newborns and children and often fade over time.
What causes a worrisome heart murmur?
In children, usually congenital defects such as holes in the heart (atrial or ventricular septal defect) or cardiac shunts. In adults, usually acquired valve damage from calcium deposits, endocarditis, or rheumatic fever.
What symptoms come with a worrisome heart murmur?
Symptoms depend on the cause and may include chest pain, shortness of breath, dizziness, fainting, blue or gray fingernails or lips, swelling, sudden weight gain, or poor infant growth. Innocent murmurs usually cause no other symptoms.
How do doctors tell if a murmur is innocent or worrisome?
They listen with a stethoscope and consider loudness (graded 1–6), location, pitch, timing, and whether the sound changes with exercise or position. Systolic murmurs are generally innocent; diastolic or continuous murmurs may signal a problem.
What is the main test for a heart murmur?
The echocardiogram is the main test used to determine the cause of a heart murmur. It uses sound waves to create pictures of the beating heart and shows how blood flows through the heart and valves.
Do innocent heart murmurs need treatment?
Usually not. If a fever or an overactive thyroid causes a murmur, it usually goes away once that condition is treated.
How are worrisome heart murmurs treated?
Treatment depends on the cause and may include medications (blood thinners, diuretics, ACE inhibitors, beta blockers) or surgery such as heart valve repair or replacement.
Can heart murmurs be prevented?
There's no known prevention for heart murmurs, but healthy lifestyle changes improve heart health and can prevent some adult conditions linked to murmurs. Many childhood murmurs disappear on their own as children grow.
References
Mayo Clinic Staff. Heart murmurs - Symptoms and causes. Mayo Clinic. May 27, 2022. https://www.mayoclinic.org/diseases-conditions/heart-murmurs/symptoms-causes/syc-20373171
Mayo Clinic Staff. Heart murmurs - Diagnosis and treatment. Mayo Clinic. May 27, 2022. https://www.mayoclinic.org/diseases-conditions/heart-murmurs/diagnosis-treatment/drc-20373175
Yoon SA, Hong WH, Cho HJ. Congenital heart disease diagnosed with echocardiogram in newborns with asymptomatic cardiac murmurs: a systematic review. BMC Pediatr. 2020;20(1):322. PMID 32605548. https://doi.org/10.1186/s12887-020-02212-8
Chillo P, Mutagaywa R, Nkya D, et al. Sub-clinical rheumatic heart disease (RHD) detected by hand-held echocardiogram in children participating in a school-based RHD prevention program in Tanzania. BMC Cardiovasc Disord. 2023;23(1):155. PMID 36966309. https://doi.org/10.1186/s12872-023-03186-y
Gardezi SKM, Myerson SG, Chambers J, et al. Cardiac auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients. Heart. 2018;104(22):1832-1835. PMID 29794244. https://doi.org/10.1136/heartjnl-2018-313082
Further reading: American Heart Association — Heart Murmurs; American Heart Association — Medications for Heart Valve Symptoms; American Heart Association — Options and Considerations for Heart Valve Surgery.
This article is for general informational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional about any medical condition.
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