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Tests and diagnosis
By Mayo Clinic staffHeart murmurs are usually detected when your doctor listens to your heart using a stethoscope during a physical exam.
To determine whether the murmur is innocent or abnormal, your doctor will consider:
- How loud is it? This is rated on a scale from 1 to 6, with 6 being the loudest.
- Where in your heart is it? And can it be heard in your neck or back?
- What pitch is it? Is it high-, medium- or low-pitched?
- What affects the sound? If you change your body position or exercise, does it affect the sound?
- When does it occur, and for how long? Systolic murmurs occur when your heart is squeezing blood out. Diastolic murmurs are heard when your heart is filling with blood. Continuous murmurs occur during the entire heartbeat cycle. Both diastolic and continuous murmurs often indicate a heart defect or disease that needs more evaluation.
Your doctor will also look for other signs and symptoms of heart problems and ask about your medical history and whether other family members have had heart murmurs or other heart conditions.
Additional tests
If your doctor suspects the heart murmur is abnormal, you may need additional tests including:
- Chest X-ray. An image is created by directing X-rays at your chest and positioning a large piece of photographic film or a digital recording plate against your back. The X-ray machine produces a tiny burst of radiation that passes through your body and produces an image on the film or digital plate. A chest X-ray shows a picture of your heart, lungs and blood vessels. It can reveal if your heart is enlarged.
- Electrocardiogram (ECG). In this noninvasive test, a technician will place probes on your chest that record the electrical impulses that make your heart beat. An ECG records these electrical signals and can help your doctor detect irregularities in your heart's rhythm and structure.
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Transthoracic echocardiogram. This noninvasive exam, which includes an ultrasound of your chest, shows detailed images of your heart's structure and function. Ultrasound waves are transmitted, and their echoes are recorded with a device called a transducer that's held outside your body. A computer uses the information from the transducer to create moving images on a video monitor. This test identifies abnormal heart valves, such as those that are calcified or leaking, and can also detect most congenital heart defects.
In some cases in which the images from a transthoracic echocardiogram are unclear, your doctor may recommend a transesophageal ultrasound. During this exam, you swallow a flexible tube containing a small transducer about the size of your index finger is guided down your throat. The transducer will transmit images of your heart to a computer monitor. Since the esophagus passes close behind your heart, the transesophageal transducer can often produce better images than can sound waves transmitted through your chest.
- Cardiac catheterization. In this test, a short tube (sheath) is inserted into a vein or artery at the top of your leg (groin) or arm. A hollow, flexible and longer tube (guide catheter) is then inserted into the sheath. Aided by X-ray images on a monitor, your doctor threads the guide catheter through that artery until it reaches your heart. The pressures in your heart chambers can be measured, and dye can be injected. The dye can be seen on an X-ray, which helps your doctor see the blood flow through your heart, blood vessels and valves to check for abnormalities.
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Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). Although more commonly used to check for heart failure, more doctors are using these tests to diagnose heart problems and to detect heart murmurs. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.
In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. Images of your heart are created from these signals, which your doctor will look at to determine the cause of your heart murmur.
