A heart and blood vessel specialist has advised people who are told they have a heart murmur not to assume the finding means they are ill, and to first establish which type of murmur they have. Dr. dr. Dafsah A. Juzar, Sp.JP(K), a consultant cardiologist, made the point during the CARES scientific conference held by Heartology Cardiovascular Hospital in Kuningan, South Jakarta, on Saturday (31/10/2026), as reported by Kompas.com.
According to Kompas.com, Dafsah said the initial question a doctor must answer is whether the extra sound is physiological or pathological. He described this investigation as the first step in assessing the finding.
Why it matters
A murmur is simply an additional sound picked up when a doctor listens to the heart, and it is often heard during routine health checks. Kompas.com reports that patients frequently worry because they treat any unusual heart sound as proof of disease. Dafsah's guidance suggests that concern, while understandable, can lead people to the wrong conclusion about their own health.
The distinction matters because the two categories point in very different directions. A physiological murmur can occur in a structurally normal heart, while a pathological one may indicate a problem with how the heart is built or how it works. Sorting one from the other shapes what testing and follow-up a patient needs.
What causes the extra sound
Kompas.com explains that a murmur arises when blood moving through the heart produces vibrations that register as an added noise. In medical terms this involves turbulence, meaning blood flow that is no longer smooth and orderly. Dafsah said these changes in flow create turbulence that becomes audible when the heart is examined.
In a physiological murmur, that turbulence can appear even when the heart's structure is normal, for instance when blood passes through the heart faster or in greater volume than usual. A pathological murmur, by contrast, may be tied to structural or functional problems, including valve disorders. Kompas.com gives the example of a valve that has narrowed or cannot close completely, which disrupts the way blood moves through the heart.
How doctors tell the two apart
Loudness alone does not settle the question. Kompas.com reports that doctors look at several features instead: when during the heartbeat the sound appears, where it is heard most clearly, and whether it travels to other parts of the body.
Dafsah said a pathological murmur almost always radiates, meaning the sound can be picked up beyond the spot where it is loudest. Kompas.com notes that this radiation can help a doctor work out which part of the heart or which valve may be affected.
Timing offers another clue. The heart has a contracting phase, called systole, when muscle squeezes blood out, and a relaxing phase, called diastole, when the chambers refill. Kompas.com reports that narrowing of the aortic valve, known as aortic stenosis, typically produces a murmur during systole, while leakage of the same valve, aortic regurgitation, generally produces one during diastole. The location of the loudest sound can further narrow the possible causes.
Even so, Kompas.com stresses that these sound characteristics cannot be used on their own to reach a diagnosis. A physical examination, the patient's symptoms and supporting tests are still needed to identify the cause.
Symptoms and history carry weight
Dafsah also said the overall condition of the patient has to be taken into account, because a murmur does not by itself show how serious a problem is. Kompas.com reports that he called for findings to be correlated with other observations, with symptoms and the course of the patient's complaints treated as important.
One thing doctors watch is a change in how well a person manages daily activity. Kompas.com describes the example of someone who previously walked without difficulty but now becomes short of breath easily or can no longer do what they used to.
Sudden shifts also warrant attention. Dafsah cited the case of a patient with no prior complaints who abruptly developed severe breathlessness. Kompas.com reports that such a change may be linked to a valve disorder or to a rupture of the tissue that supports a valve, causing it to leak.
Kompas.com adds that a doctor's assessment is needed to determine whether a murmur reflects a serious condition or not.
For patients, the practical takeaway from the conference is that a murmur is a finding to be investigated rather than a verdict. The next step is a proper evaluation in which the type of sound, its timing and spread, the patient's symptoms and any change in their condition are weighed together.
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