“Your heart has a murmur – get an echo done.” Many valve journeys in India begin with that sentence from a family doctor, a pre-employment check or an anaesthetist before unrelated surgery. What follows is often confusing: an echo report full of abbreviations, a label of “mild” or “severe”, and no clear idea of whether you need a general cardiologist, a valve specialist or simply a repeat scan next year. This article explains how to read that situation.
What a murmur actually means
A murmur is a sound made by turbulent blood flow. Some are harmless (“innocent” murmurs, common in children, pregnancy and anaemia). Others point to a valve that is narrowed (stenosis) or leaking (regurgitation), or to a hole between the heart’s chambers. A stethoscope cannot reliably tell these apart, which is why an echocardiogram is the standard next step. A plain-language explanation is given in heart murmur.
Reading the echo report: the terms that matter
An echocardiogram report typically names each valve and grades any problem. Key terms:
- Aortic stenosis (AS) – narrowing of the aortic valve; graded by valve area (cm²), mean gradient (mmHg) and peak velocity (m/s). Severe usually means an area under about 1.0 cm² and a mean gradient above about 40 mmHg.
- Mitral regurgitation (MR) – leakage of the mitral valve; graded mild, moderate or severe by the size of the leaking jet and its effect on the left atrium and ventricle.
- Mitral stenosis (MS) – narrowing, in India most often after childhood rheumatic fever; severe usually means a valve area under about 1.5 cm².
- Tricuspid regurgitation (TR) – leakage on the right side, often secondary to lung or left-heart pressure.
- Ejection fraction (EF) – pumping strength; a falling EF with a valve lesion is a signal to act sooner.
- Pulmonary artery pressure – raised pressure suggests the valve problem is straining the lungs.
Mild disease on a single echo rarely needs anything beyond follow-up. Moderate disease needs regular monitoring and attention to symptoms. Severe disease usually needs a treatment decision, even if you feel reasonably well, because the heart muscle can be quietly damaged for years before symptoms appear.
General cardiologist or valve specialist?
Most valve disease is first managed by a general cardiologist, and that is appropriate for mild and moderate lesions. The time to involve a valve-focused team is when:
- The echo shows severe stenosis or regurgitation of any valve
- Disease is moderate but you have symptoms – breathlessness, reduced stamina, swelling, palpitations, fainting
- The left ventricle is enlarging or the EF is falling on serial scans
- You have had a previous valve surgery or implant and the valve is wearing out
- You have been told surgery is “too risky” and want to know about catheter-based options such as TAVI or clip repair
- The report mentions a hole (ASD, VSD, PFO) alongside the valve findings
A valve specialist is usually an interventional or structural cardiologist, or a cardiac surgeon with a valve focus, working within a heart team that includes imaging specialists. Choosing a cardiologist in Mumbai for this stage means looking for someone whose practice includes structural valve procedures rather than only coronary work. Dr Aniruddha Pawar, MD (Internal Medicine), DM (Cardiology), FSCAI, for example, is an interventional cardiologist whose work includes TAVI, TEER and device closures, practising from a clinic in Dadar West.
What to bring to a valve consultation
- The actual echo images on CD or a link, not just the printed report; grading depends on the images
- Previous echo reports, so the doctor can see change over time
- ECG, blood tests, and any angiography or CT reports
- A list of medicines and other conditions (kidney disease, diabetes and lung disease all affect valve decisions)
- Notes on exactly what you can and cannot do now compared with a year ago
The specialist may order a transoesophageal echo (TEE), a stress echo, a cardiac CT or MRI, or a cardiac catheterisation to measure pressures directly. These refine the grade and plan the approach; they are not a sign that something has gone wrong.
The treatment menu, briefly
Depending on the valve and your overall health, options may include watchful waiting with medicines, balloon valvotomy (for rheumatic mitral stenosis), surgical repair or replacement (open or minimally invasive), transcatheter valve implantation (TAVI for the aortic valve, with newer options for the mitral and tricuspid valves), and clip-based repair for leaking valves. A good consultation explains why one route is proposed over the others for you.
Why a second opinion is reasonable
Valve decisions involve timing (now or in a year?), approach (surgery or catheter?) and device (mechanical, tissue or transcatheter?). Reasonable doctors can differ. If you have been advised a major procedure, a second opinion on heart valve treatment from a valve-focused team is normal practice, not an insult to the first doctor. Searching for a cardiologist near me is fine for routine follow-up, but for the decision itself, expertise in the specific procedure matters more than distance.
Follow-up intervals, as a rough guide
| Severity on echo | Typical review |
|---|---|
| Mild | Every 2-3 years, sooner if symptoms |
| Moderate | Every 1-2 years |
| Severe, no symptoms | Every 6-12 months, with a treatment plan agreed |
| Severe with symptoms | Prompt treatment decision |
These are general patterns; your doctor sets your own schedule.
When valve symptoms are an emergency
Severe valve disease can decompensate suddenly. Seek emergency care for fainting, chest pain at rest, breathlessness that prevents lying down or speaking, or a fast irregular pulse with dizziness. If you are already under a cardiologist in Mumbai, carry your latest echo report with you so that emergency staff know your baseline.
Disclaimer: This article is for general information only and is not a substitute for medical advice. Please consult a qualified doctor about any murmur, echo finding or valve symptom.
