Can a Class 2 Heart Murmur Be Harmless?

Has a doctor told you that you have a class 2 heart murmur, and he wants to do further testing to determine the cause? That’s what happened to me, a longstanding athlete. I decided to see a cardiologist for a basic heart health evaluation, because there is family history of heart disease.

By the time I arrived for my visit, I had already had my coronary calcium score result: zero (which means no measurable plaque buildup). Oddly, more than once I imagined that he would detect a heart murmur. “You have a heart murmur” kept sounding off in my mind.

I knew something was up when he seemed to be taking a long time during the stethoscope part of the exam. “Why is he taking so long?” I wondered as he kept placing the device in different places, listening very intently.

He told me I had a class 2 heart murmur that increased upon inspiration (inhaling) and wanted to order an echocardiogram. He also said that “most heart murmurs are harmless.” I was concerned, however, that this was a class 2 heart murmur. There are classes 1, 2 and 3.

He also ordered a blood test for hyperthyroidism, as this condition can cause a heart murmur. The test for that came back normal. And, the echocardiogram came back very normal.

The doctor then said that perhaps the class 2 murmur had been caused by my rapid heart rate during the exam, which was from anxiety.

Several days later I was at the gym working out. At around 7:15 pm, my cell phone rang and I recognized the number as being from the cardiologist. I took the call in an empty spin class room.

He told me that he had been chatting with his colleague who specialized in pediatric cardiology, and that this other doctor suggested that the class 2 murmur might be caused by congenital pulmonary arterial stenosis (narrowing of a lung artery).

My doctor commented something to the effect that he was puzzled that he didn’t have to strain at all to hear my murmur, and that it would be a smart idea to have an MR angiogram (type of MRI).

Worst case scenario regarding my class 2 heart murmur: pulmonary stenosis in which I’d be advised I’d need a balloon angioplasty. The doctor said that even though I wasn’t having any symptoms, this condition could become “more relevant” as I got older, and it would be something that needed to be watched if I didn’t have the angioplasty.

He also said that there was a good possibility that the MRA would turn up negative. Well, the MRA results were as follows: “No evidence of pulmonary artery stenosis.”

Everything else was normal as well (if you’re having an MRA to check for something specific, standard medical care is to look at other things also, such as ventricular function.)

When these results came in, my doctor was out of town, but another cardiologist from the department phoned me and said that the murmur was “functional,” and this is sometimes seen in athletes.

When my doctor returned from vacation, he e-mailed me after I sent a note to him stating that the other cardiologist attributed the heart murmur to being an athlete. My doctor’s message read as follows: “You’re right that murmurs and subtle differences in electrocardiograms are sometimes ‘normal variants’ and folks like you who are athletic may have a higher than average cardiac output (from being in great shape) which can produce heart murmurs from robust flow.”

If you’re an athlete (which includes being a gym rat) and have been diagnosed with a class 2 heart murmur, don’t panic. A class 2 heart murmur may turn out to be the result of high cardiac output.

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