A female, age 30, posed the following questions: My family doctor says that I have a systolic murmur at the apex of the heart and referred me to a cardiologist. I would like to know:
1. What is my prognosis?
2. Is there any contraindication to using birth control pills?
3. Will the murmur affect future pregnancy and the number of children I can have?
4. When will an operation be necessary?
5. Can I prevent it from becoming worse?
B. Answers
Below are the answers to the previous questions asked.
1. A soft systolic murmur over the apex of the heart is usually of no significance. It is important, however, to identify any mild area of roughness or deformity of the valve, which can later develop an infection called endocarditis. When a doctor states that a murmur is of no significance, it means that the murmur will not affect the person’s life span or activities. If you have not had rheumatic fever and there are no other murmurs and no shortness of breath, the murmur is likely due to an increased blood flow across the valve, a common finding in normal young adults and also during pregnancy. The cardiologist’s findings with the stetho¬scope, followed by a chest x-ray and electrocardiogram, usually exclude most serious problems. If some doubt exists, an echocardiogram is helpful. Echocardiography will document a degree of stenosis or regurgitation. Diastolic murmurs are always significant, whereas soft systolic murmurs are often not.

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