Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
A heart murmur is a continuous sound that is audible with a common
stethoscope, produced when blood passes through particular areas of the heart.
The heart has four chambers, two atria (singular = atrium) and two ventricles
separated by a "skeleton" of cartilage that separates each chamber. This
skeleton is made up of the atrial septum, the ventricular septum and four valves
(aortic, pulmonary, mitral and tricuspid) that direct blood flow in a specific
route within the heart allowing the most efficient use of each heart beat to
pump blood to the rest of the body.
How the heart works
Each heart beat has two phases, systole when the heart pumps and diastole
when the heart chambers fill with blood.
Blood enters the right atrium from the
body via the vena cava.
It travels through the tricuspid valve into the right
ventricle.
A systolic heartbeat sends the blood through the pulmonary valve,
which separates the right ventricle and the pulmonary artery, to the lung.
In
the lung, oxygen is delivered to red blood cells and carbon dioxide, a waste
product of metabolism, is removed.
The oxygenated blood returns to the left
atrium where it travels through the mitral valve into the left ventricle.
The
systolic heartbeat also causes the left side of the heart to contract and send
the blood through the aortic valve that separates the left ventricle and the
aorta.
Blood passes through the aorta to the body delivering oxygen to the
body's tissues.
The sound of a murmur is generated when blood flow within the heart is not
smooth and turbulence occurs. Using a stethoscope, a health care practitioner may
be able to hear a heart murmur during the physical examination. Of note, not all
heart murmurs are abnormal or dangerous, but if one is present it may signal a
structural abnormality of the heart.
What causes a heart murmur?
Functional heart murmur
Many heart murmurs are harmless and referred to as innocent or functional.
They are caused when blood rushes through the heart quickly during normal
function while no heart disease may exist. There may be an underlying medical
condition that can lead to an innocent murmur. These may include situations
where the heart beats more quickly such as
fever,
anemia, hyperthyroidism, and
pregnancy.
Congenital heart murmurs
Congenital heart murmurs are heard in the newborn. They may be due to
abnormalities in the valves, septae or arteries, and veins that carry blood to
and from the heart. In some complicated heart disease conditions there may be a combination
of all three. Many congenital heart murmurs resolve spontaneously without
medical intervention while others require surgical operations for repair.
Patent ductus arteriosus (PDA) may cause a heart murmur in a newborn.
Prior to birth birth, the aorta and pulmonary artery are connected by a small artery,
the ductus arteriosus, to complete fetal blood circulation. Shortly after birth,
this artery is supposed to close. If other congenital heart abnormalities exist,
the ductus may remain open to help maintain some blood circulation. Sometimes,
when no congenital abnormalities exist, the ductus doesn't completely close and
a murmur may exist. Many times the patent ductus arteriosus closes by itself over time. Occasionally,
medications or surgery may be required to close off the patent ductus
arteriosus.
Valve abnormalities
Abnormalities of the valves of the heart may cause a heart murmur. Any of the
heart valves may be affected and clinical symptoms depend upon the severity of
the valve damage and whether the blood flow pattern within the heart is
maintained. Each valve problem often leads to a specific character and timing of
heart murmur.
Valve stenosis is narrowing of a heart valve. This often occurs over time
as the valve scars due to injury and scarring from infection such as in
rheumatic
fever or from a congenital birth defect. Calcification of a valve may also
result in stenosis. This causes the heart muscle to work harder to push blood
through the narrowed opening and possible
heart failure.
Valve regurgitation (or insufficiency) is a valve that leaks causing blood
to pass backward against the normal blood flow pattern in the heart. A valve may have both stenosis and regurgitation.
Valve sclerosis is the mild narrowing and stiffening of the valve (most
often seen in the aortic valve) due to aging. It is associated with
atherosclerotic heart disease.
Valve
prolapse is a bowing of a valve that causes some leaking and most often involves
the mitral valve.
Endocarditis is an infection of the lining of the heart that may involve
and destroy a heart valve. The source of the infection is usually elsewhere in
the body and it travels via the bloodstream to infect the heart. Most often,
there is a previous underlying heart condition.
Holes in the walls of the heart (the septum that divides the heart chambers)
can be the source of a heart murmur.
Atrial septal defect (ASD) describes a hole
in the wall that separates the collecting chamber of the heart while a
ventricular septal defect (VSD) affects the wall dividing the pumping chamber.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
Strep throat is a sore throat caused by a bacterium called streptococcus (strep) that can be treated through antibiotics. Common symptoms of strep throat include pinkeye, runny nose, skin rash, cough, hoarseness, diarrhea and more. Complications of untreated strep throat include middle ear infections, meningitis, pneumonia, rheumatic fever, and more.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Edema is the swelling of tissues as a result of excess water accumulations. Peripheral edema occurs in the feet and legs. There are two types of edema, non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases, most commonly involving the heart, liver, and kidneys. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema is generally treated with medication.
Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Palpitations can be relieved in many patients by stress reduction, stopping cigarettes, and reduction of caffeine and alcohol.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Mitral valve prolapse (MVP) is also also known as "click murmur syndrome" and "Barlow's syndrome." Mitral valve prolapse is the most common heart valve abnormality. Signs and symptoms of mitral valve prolapse include: fatigue, palpitations, chest pain, anxiety, and migraine headaches. Echocardiography is the most useful test for mitral valve prolapse. Most patients do not need any treatment, however, patients with severe prolapse may need treatment.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Marfan syndrome is hereditary condition affecting connective tissue. A person with Marfan syndrome may exhibit the following symptoms and characteristics: dislocation of one or both lenses of the eye; a protruding or indented breastbone; scoliosis; flat feet; aortic dilatation; dural ectasia; stretch marks; hernia; and lung collapse. Though there is no cure for Marfan syndrome, there are treatments that can minimize and sometimes prevent some complications.
Heart valve disease occurs when the heart valves do not work the way they should. Symptoms of valve disease include shortness of breath, weakness or dizziness, discomfort in your chest, palpitations, swelling of your ankles, feet or abdomen, and rapid weight gain.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Alcohol intake by a pregnant mother may result in fetal alcohol syndrome (FAS) in her child. A child with FAS may be hyperactive and have a low IQ, a small head, a growth lag, short eye openings, flattened cheekbones, a short nose, a smooth, thin upper lip, shortening of the fourth and fifth fingers, and a heart murmur.
Rheumatic fever is a disease that sometimes occurs after a group A streptococcal infection of the throat. Symptoms and signs include carditis, polyarthritis, Aschoff bodies, rash, Sydenham's chorea, and fever. Treatment for rheumatic fever involves eliminating the bacteria with penicillin, erythromycin, or azithromycin. Further treatment focuses on alleviating the symptoms brought on by the body's immunologic response to the bacteria.
Group A streptococcal infections are caused by group A streptococcus, a bacteria that causes a variety of health problems, including strep throat, impetigo, cellulitis, erysipelas, and scarlet fever. There are more than 10 million group A strep infections each year.
Aortic dissection is a small tear in the large blood vessel that leads from the heart and supplies blood to the body. There are two types of aortic dissection, type 1 and type 2. Signs and symptoms of aortic dissection include a tearing or ripping pain, nausea, sweating, weakness, shortness of breath, sweating, or fainting. Treatment depends on the type of aortic dissection, and the severity of the tear in the aorta.
Congenital heart defects are heart problems that are present at birth. Genetics may play a role in some heart defects. Symptoms can range from nonexistent to severe and life-threatening. Fatigue, rapid breathing, and decreased blood circulation are a few possible symptoms of congenital heart defects. Many cases do not require any treatment. Procedures using catheters and surgery may be used to repair severe heart defects.
Heart failure is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats.
A ventricular septal defect (VSD) is a congenital heart malformation. A VSD is a hole in the wall of the heart's two lower chambers. Approximately, one in 500 infants will be born with a VSD. Treatment depends upon whether the VSD is small or large in size.
Endocarditis, a serious infection of one of the four heart valves is caused by growth of bacteria on one of the heart valves; leading to an infected massed called a "vegetation." The infection can be caused by having bacteria in the bloodstream after dental work, colonoscopy, or other similar procedures. Endocarditis symptoms include fever, fatigue, weakness, chills, aching muscles and joints, night sweats, edema in the legs, feet, or abdomen, malaise, shortness of breath and small skin lesions. Treatment for endocarditis is generally aggressive antibiotic treatment.
The heart is a very important organ in the body. It is responsible for continuously pumping oxygen and nutrient-rich blood throughout your body to sustain life. It is a fist-sized muscle that beats (expands and contracts) 100,000 times per day, pumping a total of five or six quarts of blood each minute, or about 2,000 gallons per day.
Mitral valve prolapse (also known as "click murmur syndrome" and "Barlow's syndrome") is the most common heart valve abnormality, affecting five to ten percent of the world population. A normal mitral valve consists of two thin leaflets, located between the left atrium and the left ventricle of the heart. Mitral valve leaflets, shaped like parachutes, are attached to the inner wall of the left ventricle by a series of strings called "chordae." When the ventricles contract, the mitral valve leaflets close snugly and prevent the backflow of blood from the left ventricle into the left atrium. When the ventricles relax, the valves open to allow oxygenated blood from the lungs to fill the left ventricle.
In patients with mitral valve prolapse, the mitral apparatus (valve leaflets and chordae) becomes affected by a process called myxomatous degeneration. In myxomatous degeneration, the structural protein collagen forms abnormally and caus...
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