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Your Good Health: Heart murmur in older adult needs evaluation

An echocardiogram might be needed to get to the cause of the issue
Dr. Keith Roach

Dear Dr. Roach: My husband is 80 years old and a survivor of liver cancer after receiving four years of immunotherapy. On a recent follow-up visit to his oncologist, the doctor told him that he has a heart murmur. He takes medication for his thyroid and adrenal glands.

Could you please explain what a heart murmur is, what causes them and which treatment is recommended? Is it unusual for a heart murmur to suddenly appear?


A heart murmur is when the examiner can hear blood flowing through one of the valves of the heart (or through a different heart structure, such as a patent ductus arteriosus or a septal defect). This can happen with a damaged valve, such as one that is tight (called stenosis) or one that leaks, leading the blood to flow the wrong way through the valve (called incompetence or insufficiency).

However, it can also be heard in some people with structurally normal hearts, especially when blood flow is high. High blood flow can happen with anemia or when thyroid levels are too high. Anemia is extremely common in those being treated for cancer, but after four years, I would expect that his blood count would return to normal. That’s not always the case, though.

There are less-common causes of heart murmurs. Infection can damage the valve, causing a murmur, and an enlarged heart can cause obstruction and a heart murmur. Still, most of the time, a heart murmur in a young adult is “innocent” and does not indicate disease of the heart or its valves.

Given your husband’s age and medical history, it may be worth looking into further. A new onset murmur at his age is more concerning than in a younger person, since valve diseases tend to occur at an older age. Reviewing his medical history is important, since the murmur may have been noticed before and he might not have been told about it. (I tell all my patients when I hear one for this reason.)

An expert can tell a great deal about the heart by listening to it carefully and may be able to reassure you and your husband that there is a low risk of serious disease. If concern still lingers, an echocardiogram will almost always give the answer.

Dear Dr. Roach: My husband and I, both 78, will be traveling for several months to countries where the Centers for Disease Control and Prevention recommend the hepatitis B vaccine, which we’ve never gotten. After asking our general physicians, talking to pharmacists, contacting the local Department of Health, and looking online, we can’t get a straight answer on how many Hep B injections to get or how far apart to space them. Can you help? We are departing in three months.


There are four different hepatitis B vaccines available. Three of them are given as a three-dose series, with the second given a month after the first and the third given six months after. However, one brand of the vaccine (HepB-CpG) is a two-dose series, with the second dose given one month after the first. That will give you full protection before your trip.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible.