Diastolic Murmur

What is a diastolic heart murmur?

A diastolic (die-a-STOL-ic) heart murmur is an abnormal sound that occurs during diastole (die-AS-tuh-lee), when your heart rests between beats. In a blood pressure reading, the diastolic pressure is the lower number.

A murmur may sound like a “swish” or “whoosh.” It occurs because of blood flowing in your heart’s valves.

Often, heart murmurs aren’t dangerous. But sometimes, they point to heart conditions. If you have a diastolic murmur, your healthcare provider may give you tests to check for other heart problems.

What is the difference between a diastolic and systolic murmur?

A diastolic murmur occurs when your heart relaxes between heartbeats. Diastolic murmurs are often harder to hear than systolic murmurs. A systolic heart murmur occurs when your heart muscle contracts.

What is the difference between an innocent and abnormal heart murmur?

Doctors call it an innocent murmur when you have a heart murmur but don’t have signs of another underlying heart condition. An abnormal heart murmur may require tests to figure out the murmur’s underlying cause.

Usually, innocent heart murmurs don’t need treatment. Abnormal heart murmur treatment can vary based on your heart condition.

What causes a diastolic murmur?

Diastolic heart murmurs may occur because of problems with your heart valves. Heart valve problems that can lead to a diastolic murmur include:

• Aortic regurgitation: The aortic valve that lets blood travel from your heart to your aorta doesn’t close tightly, causing leaks.
• Pulmonic regurgitation: The pulmonary valve, which connects your heart and lungs, doesn’t close tightly, causing leaks.
• Mitral stenosis: The mitral valve, which connects the top left chamber of your heart (left atrium ) to the bottom left chamber of your heart (left ventricle) is narrowed.
• Tricuspid stenosis: The tricuspid valve, which connects the top right chamber (right atrium) to the bottom right chamber (right ventricle) is narrowed.

You may also develop a diastolic heart murmur if you have:

• Certain types of congenital heart disease (heart disease you are born with).
• Endocarditis, an infection in your heart’s inner lining and/or valves.
• Long-term effects from rheumatic fever.

What are the symptoms of a diastolic heart murmur?

The symptoms of a diastolic murmur depend on the underlying cause. If the murmur is due to a stenotic (narrowed) or regurgitant (leaky) valve, you may experience:

• Shortness of breath.
• Swelling in your abdomen or legs.
• Palpitations.
• Fatigue.
• Dizziness.
• Passing out.
• Cough.

How is a diastolic heart murmur diagnosed?

Usually, your provider first notices a heart murmur when listening to your chest with a stethoscope. Your provider assesses a few factors, such as:

• Does changing position or exercising affect the sound?
• How loud is the sound?
• What pitch is it?
• When does the sound occur, and for how long?
• Where in your heart is the murmur?

What tests might I have to diagnose a diastolic heart murmur?

Your provider may refer you to a cardiologist (doctor specializing in the heart) for additional tests. Heart tests can tell your provider about your heart’s rhythm and structure. Your provider may recommend:

• Echocardiogram: This is one of the most common tests used to evaluate a heart murmur. An echocardiogram (echo) uses ultrasound to take pictures of your heart and evaluate the function of your heart muscle and valves.
• Chest X-ray: Uses safe beams of radiation to create images of your heart, bones and lungs.
• Electrocardiogram (EKG): Records your heart’s electrical activity.

What is the diastolic murmur grading scale?

Providers analyze heart murmurs based on their intensity. They may use a grading scale to measure the murmur’s volume, pitch and how long it lasts (duration). Providers grade diastolic heart murmurs on a scale of one through four, with one being the faintest and four being the loudest. They grade systolic murmurs on a scale of one through six, with one being the faintest murmur and six being the loudest.

How is a diastolic heart murmur treated?

Treatment depends on the underlying cause. If the murmur is due to a valve problem, your provider may recommend medications, valve repair or valve replacement.

Medications may include:

• Angiotensin-converting enzyme (ACE) inhibitors, such as benazepril (Lotensin®) or captopril (Capoten®), help reduce your blood pressure.
• Beta-blockers, such as bisoprolol (Cardicor®) or metoprolol (Lopressor®), decrease your blood pressure and heart rate.
• Blood thinners, such as warfarin (Coumadin®) or aspirin (Bayer®, Zorprin®), make it less likely your blood can form clots in your blood vessels or organs.
• Diuretics, or water pills such as furosemide (Lasix®) or torsemide (Demadex®), help your body get rid of excess fluid.

You may need heart valve surgery or other surgery if you have a damaged or leaky heart valve. Procedures may include:

• Valve repair: Surgery focuses on opening a narrowed valve or tightening a leaky valve.
• Valve replacement: If you have severe valve stenosis (narrowing), your provider replaces a heart valve with a mechanical or donor one.

How can I prevent a diastolic murmur?

There is no guaranteed way to prevent a diastolic murmur. Once your provider diagnoses a diastolic murmur, it’s important to follow up with them regularly so they can monitor the underlying cause of the murmur (such as a valve problem).

You can increase your heart health by practicing healthy lifestyle habits. You may:

• Eat a diet full of fruits, vegetables and whole grains.
• Get aerobic exercise — at least 150 minutes per week.
• Limit your intake of alcohol and caffeine.
• Quit smoking.
• Reduce stress by practicing mindfulness or meditation.
• Sleep at least seven to eight hours each night.

What is the outlook for a diastolic murmur?

The outlook depends on the underlying condition. Thankfully, there are excellent treatment options available for valve problems. Practicing healthy lifestyle habits can also help you live a fuller life with a heart murmur.

What else should I ask my healthcare provider?

You may also want to ask your healthcare provider:

• What is the most likely cause of a diastolic murmur?
• What kinds of tests do I need?
• What are my treatment options?
• What do I need to know about managing underlying conditions?
• Do I need to see a specialist?
• Should I make any lifestyle changes to improve my heart health?

A note from Cleveland Clinic

Diastolic heart murmurs are abnormal sounds when your heart rests between beats. Many diastolic heart murmurs don’t need treatment, but sometimes, they point to another heart condition. If your provider detects a heart murmur, you’ll likely have several tests to find out if you have an underlying heart condition. Diastolic murmur treatment may include medications or surgery. Practicing healthy habits can also improve your quality of life with a diastolic heart murmur.