Treatment

An innocent heart murmur generally doesn't require treatment because the heart is normal. If an innocent murmur is caused by an illness, such as fever or an overactive thyroid (hyperthyroidism), the murmur will go away once that condition is treated.

An abnormal heart murmur is closely monitored by your doctor over time. Treatment depends on the heart condition causing the murmur and may include medications or surgery.

Medications

The medication your doctor prescribes depends on the specific heart problem you have. Some medications your doctor might give you include:

• Blood thinners (anticoagulants). This type of medicine prevents blood clots from forming in your heart and causing a stroke. Your doctor may prescribe traditional anticoagulants, such as aspirin, warfarin (Jantoven) or clopidogrel (Plavix). Newer blood thinners, called direct-acting oral anticoagulants (DOACs), also may be prescribed. Examples include apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa) and others.
• Water pills (diuretics). Diuretics remove excess fluid from your body, which can help treat other conditions that might worsen a heart murmur, such as high blood pressure.
• Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors lower your blood pressure. High blood pressure can worsen underlying conditions that cause heart murmurs.
• Statins. Statins help lower your cholesterol. Having high cholesterol seems to worsen some heart valve problems, including some heart murmurs.
• Beta blockers. These drugs lower your heart rate and blood pressure. They're used for some types of heart valve problems.

Doctors used to recommend that most people with abnormal heart murmurs take antibiotics before visiting the dentist or having surgery to prevent bacteria from getting into the lining of the heart (infective endocarditis).

Doctors no longer recommend antibiotics before procedures, except for people who have an artificial heart valve, history of a heart valve infection or a congenital heart defect that increases the risk of infective endocarditis.

Surgery

Surgery may be needed to correct a damaged or leaky valve that causes a heart murmur. Depending on your heart condition, your doctor may recommend one of several heart valve treatment options.

Valve repair

To repair a valve, your doctor may recommend one of the following procedures:

• Balloon valvuloplasty. This procedure is performed to relieve a narrowed valve. During a balloon valvuloplasty, a small catheter containing an expandable balloon is threaded into your heart, placed into the valve and then expanded to help widen the narrowed valve.
• Annuloplasty. In this procedure, your surgeon tightens the tissue around the valve by implanting an artificial ring. This allows the leaflets to come together and close the abnormal opening through the valve.
• Repair of structural support. In this procedure, your surgeon replaces or shortens the cords that support the valves (chordae tendineae and papillary muscles) to repair the structural support. When the cords and muscles are the right length, the valve leaflet edges meet and eliminate the leak.
• Valve leaflet repair. In valve leaflet repair, your surgeon surgically separates, cuts or pleats a valve flap (leaflet).

Valve replacement

In many cases, the valve has to be replaced. Options include:

• Open-heart surgery. This is the main treatment for severe valve stenosis. Your surgeon removes the narrowed valve and replaces it with a mechanical valve or a tissue valve. Mechanical valves are made from metal. They are durable, but carry the risk of blood clots forming. Tissue valves may come from a pig, cow or human deceased donor. They often eventually need replacement.
• Ross procedure. This type of heart valve replacement uses your own pulmonary valve (autograft). It's not often used due to the availability of less complex, yet effective, options.

• Transcatheter aortic valve replacement (TAVR). This is a less invasive approach to replacing a heart valve. TAVR involves replacing the aortic valve with a prosthetic valve through an artery in your leg or in a small incision in your chest.

  In some cases, a valve can be inserted through a catheter into a tissue replacement valve that needs to be replaced (valve-in-valve procedure).

  TAVR is usually reserved for people with severe aortic valve stenosis who are at increased risk of complications from aortic valve surgery.