A heart murmur—the swishing sound of turbulent blood flow in the heart—may sometimes be detected during a sports physical exam and introduce doubt as to whether you should continue to play sports. The answer to the question, “Can you play sports with a heart murmur?” depends on:
- Whether the murmur has been present from birth
- The cause of the murmur
- Whether you have any other symptoms
- The findings of diagnostic tests
Congenital vs. Recent Heart Murmur
A heart murmur that an athlete has had since birth is more likely the result of an underlying condition rather than a consequence of physical activity. Congenital heart defects are often the cause of sudden cardiac arrest in children. These conditions include:
- A hole in the heart
- Cardiac shunts
- A narrowing or leak in one or more heart valves
- Hypertrophic cardiomyopathy (an abnormal thickening of the heart muscle)
Other Causes of Heart Murmurs
Other causes of heart murmurs can be physiological or pathological. A physiological murmur is a normal and benign finding whereas an abnormal heart murmur may require treatment.
Physiological Heart Murmur
Increased cardiovascular fitness, on its own, can cause changes in the heart muscle that lead to an innocent murmur. Young athletes and endurance athletes, in particular, can develop morphological adaptations such as:
- A slower heart rate
- Systolic ejection murmur in the upper left ventricle
- A third heart sound
- Lateral displacement of the point of maximal impulse (PMI)
- Increased circulatory volume
Pathological Heart Murmur
Abnormal heart murmurs that are the result of an underlying condition rather than increased fitness can mean a higher risk of sudden cardiac death. Risk factors for an abnormal heart murmur include:
- High blood pressure (hypertension)
- High blood pressure in the lungs (pulmonary hypertension)
- Heart disease
- Endocarditis (a heart infection)
- Valve calcification
- Autoimmune disorders
Symptoms occur with an abnormal heart murmur that don’t occur with physiological murmurs. You should tell your doctor straight away if you experience:
- Chest pain
- Shortness of breath
- Irregular heartbeat
- Fainting episodes or dizziness
- Declining athletic performance
The timing, pitch, and volume of a heart murmur (on a scale from 1 to 6) will help the doctor work out if a heart murmur is anything to worry about. If the doctor hears anything that could indicate a harmful heart abnormality, he or she may recommend an echocardiogram, electrocardiogram, and/or chest X-ray.
In an echocardiogram, sound waves are used to create an image of the heart valves and heart chambers. In an electrocardiogram, a machine records the heart’s electrical activity. A chest X-ray may be used to take a picture of the heart, lungs, and blood vessels and determine whether the heart is enlarged.
So Are Sports Off Limits With a Heart Murmur?
In most cases, a heart murmur should not preclude you from playing sports—so long as you take steps to manage your condition. For athletes who need to have their heart murmur treated, the options typically include medications, surgery, or dietary changes—depending on the cause. A hole, leak, or narrowed valve may require surgery whereas dietary changes may be sufficient for addressing high blood pressure.
In some cases, a sports cardiologist may recommend lowering the intensity of exercise or finding a new hobby off the field. And whether or not you continue to play sports, it’s a good idea to have an automated external defibrillator such as the Philips HeartStart FRx on-site wherever sports activity takes place. You never know when an undetected heart issue may lead to a sudden cardiac arrest and timely defibrillation could save a life.