Diagnosis

Heart murmurs are usually detected when your doctor listens to your heart using a stethoscope during a physical exam.

To check whether the murmur is innocent or abnormal, your doctor will consider the following:

• 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? Does exercising or changing body position affect the sound?
• When does it occur, and for how long? A murmur that happens when the heart is filling with blood (diastolic murmur) or throughout the heartbeat (continuous murmur) may signal a heart problem. Tests need to be done to find the cause. A murmur that occurs when the heart is emptying (systolic murmur) generally is an innocent heart murmur. Innocent heart murmurs aren't a sign of heart disease and don't require treatment.

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.

Tests

If your doctor thinks the heart murmur is abnormal, you or your child may need additional tests, including:

• Echocardiogram. This test is the main test used to determine the cause of a heart murmur. An echocardiogram uses ultrasound waves to create detailed images of your heart's structure and function. It can help identify abnormal heart valves, such as those that are hardened (calcified) or leaking, and can also detect most heart defects.
• Chest X-ray. A chest X-ray shows an image of your heart, lungs and blood vessels. It can reveal if your heart is enlarged, which may mean an underlying condition is causing your heart murmur.
• 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 look for heart rhythm and structure problems.

• Cardiac catheterization. In this test, a catheter is inserted into a vein or artery in your leg or arm 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 problems. This test is generally used when other tests have been inconclusive.