Many murmurs are discovered unexpectedly when a doctor listens to someone's heart with a stethoscope during a routine physical exam. In other cases, when someone is having symptoms of heart problems, the doctor will ask questions related to a specific type of heart ailment. For example, he or she may ask about a history of rheumatic fever because rheumatic fever during childhood can cause heart valve abnormalities later in life. Because endocarditis can follow intravenous drug use or certain medical or dental procedures, your doctor may ask about these risk factors. If the patient is an infant, the doctor will ask whether there is a family history of congenital heart problems.
Because specific heart problems are associated with specific types of murmurs, your doctor often will make a tentative diagnosis based on your medical history, symptoms and the murmur's distinctive sound and timing (whether the murmur occurs when the heart is pumping or resting). As part of your medical evaluation, your doctor may order diagnostic tests, which may include:
Electrocardiography (EKG) – This painless procedure measures the electrical activity of the heart.
Chest X-ray – This is used to check for an enlarged heart and for certain congenital abnormalities.
Echocardiography – This noninvasive test uses sound waves to create an image of the heart's structure, including the structure of its valves.
Doppler echocardiography – This test is similar to echocardiography, but it creates an image of the heart's blood flow patterns rather than its structure.
Cardiac catheterization – In this test, a small, sterile tube called a catheter is guided into the heart to measure pressures and oxygen levels in the heart's chambers. A dye is injected through the catheter to produce an X-ray image of the heart's internal structure and blood flow patterns.
Blood tests – Blood tests are used to check for infection in people with suspected endocarditis or pericarditis.