Classification Of Heart Murmurs

There are several categories of heart murmurs or heart murmurs depending on their intensity, tone and location. Regardless, they are generally mild although they should be monitored.

Heart murmurs are caused by vibrations caused by turbulence in blood flow as it passes through the heart or large vessels. In other words, they are noises that appear during the heartbeat cycle and are produced by turbulent blood flow in or near the heart. These heart murmurs can be heard through a stethoscope.

Moreover, this alteration can be present from birth or appear throughout the life cycle. When it is from birth, murmurs to the heart are said to be congenital. It should now be clarified that murmurs in the heart are not a disease at all, but it is strongly recommended that you monitor them as they can promote the development of undiagnosed heart problems.

Characteristics of heart murmurs

The characteristics of murmurs in the heart are defined according to their intensity, frequency of noise, area of ​​localization in the thorax and in the cardiac cycle, that is, whether they occur during systole or diastole.

In addition, the degree of intensity of the breath is determined by the volume of blood responsible for the turbulence in the blood flow or the pressure gradient that this turbulence causes. It is important to note that the degree of intensity of the murmur does not directly relate to the severity of the heart injury.

How to classify heart murmurs?

It was Levine who introduced in 1933 the classification that is used today. This professional then bases the classification on intensity, as explained previously. According to Levine, there are 6 classes of heart murmurs depending on their intensity. There are different grades:

• 1: Weak and difficult to discern. To be able to hear them, auscultation of the patient’s cardiac cycles is necessary
• 2:  Low and easy to auscultate
• 3: Moderate, without accompanying shuddering, i.e. without tangible vibration in the rib cage as blood passes
• 4:  Strong and accompanied by tremors
• 5: Very strong. They can be heard with the stethoscope located away from the chest
• 6:  So intense that you can hear them from a distance, without a stethoscope

Other classifications of heart murmurs

Apart from the classification according to the degree of intensity, it is also possible to group heart murmurs according to their other characteristics. If we take into account their duration, we can classify them as diastolic or systolic.

On the other hand, if we refer to the shape of the breaths, they can be singing, increasing, decreasing, or a combination of the last two aspects. As for localization, it refers to the place where the breath is most intense. Thus, there are 6 auscultation areas in the anterior chest wall to identify a murmur:

• The second right intercostal space
• Between the second and the fifth left intercostal space.
• The fifth intercostal space at the level of the left clavicle

It is also possible to classify the blasts according to their irradiation. This characteristic refers to the area affected by the breath. As a rule, it takes the direction of blood flow. However, depending on its tone, it can be low or high. The quality is a specific characteristic that each breath can have, that is to say that it can be, among other things, musical, blowing or snoring.

Treatment

Typically,  heart murmurs are mild  and therefore do not require treatment. Sometimes follow-up tests are needed to make sure they are not causing serious undiagnosed heart problems.

In the event that treatment is needed, it will aim to address the cause of the murmur. For example, if the murmurs are functional and caused by an illness such as fever or hyperthyroidism, they will go away once the condition is treated.

In other cases, heart murmurs cannot be treated with medication and surgery is required. Depending on the condition,  the doctor will recommend one of these options to treat a damaged or perforated valve :

• Valvuloplasty
• Annuloplasty
• Repair of structural support
• Open heart surgery
• Valve repair

In any case, before suspecting a heart murmur, it is best to seek the advice of a doctor. Only he is able to assess the situation and, if so, know how to deal with the problem.