Heart murmurs detected in older adults deserve further evaluation

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

Can you explain what a heart murmur is, what causes it, and recommended treatments? Is a sudden heart murmur abnormal?

— MC

Dear host: A heart murmur is when the examiner can hear blood flowing through a heart valve (or through a different heart structure, such as a patent ductus arteriosus or a ventricular septal defect). This condition can occur when the valve is damaged, such as it being too tight (called stenosis) or leaking, causing blood to flow through the valve in the wrong way (called insufficiency or insufficiency).

However, some people with normal heart structures can also hear this sound, especially when blood flow is higher. High blood flow may occur with anemia or high thyroid levels. Anemia is extremely common in people undergoing cancer treatment, but after four years, I expect their blood counts to return to normal. But this is not always the case.

There are also less common causes of heart murmurs. Infection can damage the valves, causing murmurs, and an enlarged heart can cause obstruction and heart murmurs. Still, most of the time, heart murmurs in young people are “harmless” and do not indicate disease in the heart or its valves.

Given your husband’s age and medical history, it may be worth investigating further. At his age, a new murmur is more worrisome than in a younger person because valve disease tends to occur at an older age. It is important to review his medical history because the murmur may have been noted before but he may not have been informed of it. (I tell all my patients when I hear someone for this reason.)

A specialist can learn a lot about your heart by listening carefully and can reassure you and your husband that the risk of serious illness is low. If the problem persists, an echocardiogram can almost always provide the answer.

Dear Dr. Roach: My husband and I are both 78 years old and we will be traveling for several months to a country where the Centers for Disease Control and Prevention recommends the Hepatitis B vaccine, but we have never had it. After asking our GP, talking to pharmacists, contacting the local Department of Health and looking online, we couldn’t get a straight answer as to how many doses of hepatitis B vaccine should be given or how far apart they should be. Can you help me? We are leaving in three months.

——PM

Dear Prime Minister: There are four different hepatitis B vaccines available. Three of the doses are given in a three-dose series, with the second dose given one month after the first dose and the third dose six months later. However, one brand of vaccine (HepB-CpG) is a two-dose series, with the second dose given one month after the first dose. This will provide you with complete protection before traveling.

Readers can email questions to ToYourGoodHealth@med.cornell.edu.