How is a diastolic heart murmur typically diagnosed and treated?

From the Guidelines

Diastolic heart murmurs are typically diagnosed through a combination of physical examination and echocardiography, with treatment depending on the underlying cause, as recommended by the American College of Cardiology/American Heart Association guidelines 1. The diagnosis of diastolic heart murmurs involves a thorough physical examination, including cardiac auscultation to note the timing, location, intensity, and radiation of the murmur.

• Echocardiography is a crucial diagnostic tool, as it visualizes valve structure and blood flow patterns, helping to identify the underlying cause of the murmur.
• Additional tests, such as electrocardiogram (ECG), chest X-ray, cardiac MRI, or cardiac catheterization, may be necessary in complex cases. Treatment of diastolic heart murmurs targets the underlying condition causing the murmur.
• For aortic regurgitation, medications like ACE inhibitors (e.g., lisinopril 10-40 mg daily), angiotensin receptor blockers, or beta-blockers (e.g., metoprolol 25-200 mg daily) may be prescribed to reduce blood pressure and cardiac workload.
• Mitral stenosis might be managed with diuretics like furosemide (20-80 mg daily) to reduce fluid retention, beta-blockers to control heart rate, and anticoagulants such as warfarin (dose adjusted to maintain INR 2-3) if atrial fibrillation is present.
• In severe cases, interventional procedures like balloon valvuloplasty or surgical valve repair/replacement may be necessary, as outlined in the guidelines 1. Regular follow-up with a cardiologist is essential to monitor disease progression and treatment effectiveness, typically every 6-12 months with repeat echocardiography to assess valve function.
• The American College of Cardiology/American Heart Association guidelines recommend echocardiography for asymptomatic patients with diastolic murmurs, continuous murmurs, holosystolic murmurs, late systolic murmurs, murmurs associated with ejection clicks, or murmurs that radiate to the neck or back 1.
• Echocardiography is also recommended for patients with heart murmurs and symptoms or signs of heart failure, myocardial ischemia/infarction, syncope, thromboembolism, infective endocarditis, or other clinical evidence of structural heart disease 1.

From the Research

Diagnosis of Diastolic Heart Murmur

• A diastolic heart murmur is typically diagnosed through cardiac auscultation, which can identify patients who require further evaluation and management 2.
• The diagnosis of a diastolic murmur is informative in the diagnosis of valvular heart disease, such as mitral stenosis and aortic regurgitation 3.
• Echocardiography is often used to further investigate diastolic murmurs and underlying valvular pathology 2.

Treatment of Diastolic Heart Murmur

• The treatment of a diastolic heart murmur depends on the underlying cause of the murmur, such as valvular heart disease or hypertrophic cardiomyopathy.
• In cases of valvular heart disease, treatment may involve medication or surgery to repair or replace the affected valve 2.
• In cases of hypertrophic cardiomyopathy, treatment may involve medication or surgical septal myectomy to reduce the obstruction caused by the hypertrophied septum 3.

Associated Conditions

• Diastolic murmurs can be associated with various conditions, including:
  • Mitral stenosis 3
  • Aortic regurgitation 3, 4
  • Hypertrophic cardiomyopathy 3
  • Mitral valve prolapse 5
  • Bioprosthetic valve dysfunction 6
• The presence of a diastolic murmur can be an important clue to the diagnosis of these conditions, and cardiac auscultation can be a useful tool in their diagnosis 2, 6.