There are certain things patients tell you in a pharmacy that make you stop what you are doing.
One of them is:
“The doctor said I’ve got a heart murmur, but it’s nothing to worry about.”
Sometimes it genuinely isn’t anything to worry about.
But sometimes that innocent-sounding murmur is the first clue that one of the heart valves isn’t working properly.
And this is something I think people should understand a little better.
https://www.bhf.org.uk/informationsupport/conditions/heart-murmurs
The heart has four chambers and four valves. The valves are there to make sure blood moves in the right direction.
Think of them as doors.
They should open when blood needs to pass through and close afterwards so that the blood doesn’t go backwards.
When one of these valves becomes narrowed or doesn’t close properly, the heart has to compensate.
At first, you may not notice anything.
That is one of the problems.
The heart is very good at hiding trouble
I’ve seen plenty of people who look perfectly well while collecting their medicines, chatting away and complaining about everything from their neighbours to the price of petrol.
Then, almost as an afterthought, they mention:
“I get a bit breathless walking up the stairs these days.”
Or:
“My legs have started swelling.”
Or:
“I have to stop halfway up the hill.”
And because these changes happen gradually, people often adapt to them.
They walk a little slower.
They stop for a rest.
They avoid the stairs.
They tell themselves they’re getting older.
But sometimes the heart is working considerably harder than it should.
One of the common valve problems in older adults is aortic stenosis.
The aortic valve sits between the main pumping chamber of the heart and the aorta, the large artery that carries blood around the body.
With aortic stenosis, the valve becomes narrowed and doesn’t open properly.
The heart then has to push harder to force blood through that narrowed opening.
Imagine trying to push water through a garden hose that has been squeezed almost shut.
The pump has to work harder.
The same principle applies to the heart.
Why does the valve become narrowed?
There are different causes.
As we get older, calcium can gradually build up around the valve.
The valve becomes stiff and doesn’t open as freely.
Some people are born with a valve that has an abnormal structure, making problems more likely later in life.
And there are other conditions that can damage heart valves.
The important point is that valve disease isn’t simply something you can feel.
It may sit quietly for years.
A doctor listening to the heart with a stethoscope may hear a murmur.
That doesn’t automatically mean there is serious disease.
But it may be the reason an echocardiogram is arranged.
The echocardiogram is the important bit
An echocardiogram is essentially an ultrasound scan of the heart.
It can show how well the heart is pumping and, importantly, what the valves are doing.
It can assess whether a valve is narrowed or leaking and give an indication of how severe the problem is.
This is why I would never dismiss a patient who tells me they have been told they have a murmur.
The murmur itself isn’t the diagnosis.
It is a clue.
What might you actually notice?
This is where patients sometimes surprise me.
Someone may tell you:
“I can’t walk as far as I used to.”
“My chest feels tight when I walk quickly.”
“I get dizzy sometimes.”
“I get breathless going upstairs.”
Or:
“My ankles are swollen by the evening.”
These symptoms can have dozens of causes.
They don’t automatically mean valve disease.
But breathlessness, chest discomfort, dizziness or fainting in someone with known valve disease deserves proper attention.
Particularly if it is getting worse.
One symptom I would take especially seriously is fainting or nearly fainting during exertion.
That’s not something I’d advise someone to simply put down to age.
Not every valve problem is stenosis
Another common problem is a valve that doesn’t close properly.
This is called regurgitation.
Instead of blood moving forward efficiently, some of it leaks backwards through the valve.
Again, the heart may compensate for this for a long time.
But eventually the extra workload can cause the heart chambers to enlarge and, in some people, contribute to heart failure.
And this is where the different conditions we have discussed in previous Health Matters articles start connecting.
Heart disease rarely lives in a neat little box.
High blood pressure can put extra strain on the heart.
Coronary artery disease can damage the heart muscle.
Valve disease can increase the workload on the heart.
Atrial fibrillation can develop alongside structural heart problems.
One problem can influence another.
What can be done?
It depends entirely on the valve and how badly it is affected.
Some people simply need monitoring.
Others may need medicines to control symptoms or reduce the strain on the heart.
And when a valve becomes severely diseased, there are procedures that can repair or replace it.
For some patients, traditional open-heart surgery is appropriate.
For others, particularly people who are older or considered higher risk for conventional surgery, less invasive procedures may be possible.
One example is TAVI, where a new aortic valve is inserted using a catheter rather than replacing the valve through conventional open-heart surgery.
Medicine has come a long way.
But the first step is still recognising that there is a problem.
What I would say to a patient
If you have been told you have a heart murmur, don’t panic.
A murmur does not automatically mean you have a dangerous heart condition.
But don’t ignore it either.
Ask what caused it.
Ask whether you need an echocardiogram.
And if you’ve already been diagnosed with valve disease, pay attention to changes in your exercise tolerance, breathlessness, chest discomfort, dizziness, fainting or ankle swelling.
Don’t wait until you are dramatically unwell before mentioning it.
I’ve always thought one of the most useful things a pharmacist can do is notice the small changes.
We see people regularly.
Sometimes more often than they see their doctor.
We notice when someone who normally walks into the pharmacy suddenly arrives looking exhausted.
We hear the little comments.
“I’ve been getting more breathless lately.”
“I don’t seem to have the energy I used to.”
“My doctor says I’ve got a murmur.”
Individually, these comments may not seem like much.
Put together, they can sometimes tell you that something needs looking at.
And that’s the message I would leave you with.
Don’t ignore changes in what your heart allows you to do.
Getting older may slow you down.
But a significant change in your ability to walk, climb stairs or exercise shouldn’t automatically be blamed on age.
Sometimes your heart is trying to tell you something.
Listen to it.
Until next time, look after your health — and don’t ignore the small warning signs.
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