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How one Utah woman developed a heart murmur after getting a strep infection



PROVO, Utah – In 2003, Sheana Nelson decided to go on a mission for The Church of Jesus Christ of Latter-day Saints. Her destination was Mongolia, so the then-Washington State resident traveled to the Missionary Training Center in Provo, Utah to learn Mongolian before she departed for central Asia.

She saw University of Utah Health cardiologist John Ryan, M.D. A nurse on Ryan’s team listened to her heart and Sheana learned she had, she says, “a really good example of a heart murmur.” Ryan let her hear it.

“The best way to describe it is like a baby on ultrasound,” she recalls. “My heart had more of a whooshing sound to it than a normal, solid thud-thud.”

Heart murmurs are deceptive issues in cardiology. Sometimes they’re nothing to worry about. “If you do an ultrasound and find that there is no problem with heart valves or no obstruction, that’s called ‘an innocent murmur,’” Ryan explains. “It does not cause damage, but it’s worth knowing.”

Other times, murmurs can signal serious cardiac problems—even life-threatening ones like Sheana’s. But how to tell the difference?

The answer often lies in whether the murmur—what Ryan calls “turbulent blood flow within the heart”—is new or not. Sometimes it’s the result of an uneven amount of blood going backwards, called regurgitation. Sometimes it’s due to the narrowing of a valve. In some cases, patients are born with a heart murmur or develop it at a young age. But others go through many physicals and primary care visits until, out of the blue, a provider notes that she hears a heart murmur during a routine check-up.

Underlying damage is a concern if heart valve problems exist. Symptoms can include shortness of breath or starting to retain fluid. A leaky or narrowed valve—examples of valvular disease—or a heart beating so quickly it impedes blood flow can all require surgery. “If valvular heart disease causes heart failure, the treatment is to replace or repair the valve,” Ryan says. And that can mean open-heart surgery.

The good news in all of this is that despite the potential variety of diagnoses, determining a murmur’s innocence isn’t an invasive or traumatic experience. Echocardiograms “are so straightforward,” Ryan says. “There’s no radiation, no stress, and no trauma. No damage can come from it.”