🎯 Bottom Line Up Front
A functional heart murmur, also known as an innocent, physiologic, or benign murmur, is a harmless sound made by blood circulating normally through the heart’s chambers and valves. These murmurs are extremely common, with up to 72% of children having a murmur at some point during childhood and adolescence. Less than 1% of murmurs are pathological in children, making innocent murmurs the most common type of heart murmur.
Functional heart murmurs are primarily due to physiological conditions outside the heart rather than structural defects in the heart itself. They often occur during periods of increased blood flow such as exercise, fever, pregnancy, anemia, or hyperthyroidism. Many innocent murmurs present in childhood will disappear by adulthood, though some may persist throughout life without causing any health problems.
For life insurance purposes, functional heart murmurs are considered benign findings that typically have minimal impact on underwriting decisions. Since these murmurs do not carry any morbidity or mortality risk and represent normal heart function, most insurance companies view them favorably once properly documented as innocent. The key is having appropriate medical evaluation to confirm the murmur’s innocent nature.
Children who will have a heart murmur during childhood/adolescence
Percentage of childhood murmurs that are actually pathological
Prevalence of vibratory innocent heart murmurs in schoolchildren (ages 5-14)
Children estimated to have a heart murmur from time to time
Understanding Functional Heart Murmurs: Normal Heart Sounds
Key insight: Functional heart murmurs are harmless sounds made by blood circulating normally through the heart’s chambers and valves, representing normal physiology rather than disease.
Innocent Nature
An innocent murmur is simply a noise that can sometimes occur as blood passes through a normal heart, with no symptoms associated
Normal Physiology
Caused by physiologically increased turbulent flow in otherwise normal hearts, not structural defects
Common Occurrence
Extremely common in children and can persist into adulthood without any health implications
The human heartbeat is usually steady: lub-dub, lub-dub. In some people, the blood makes an extra noise as it flows through the heart, called a murmur. Innocent heart murmurs are harmless sounds made by the blood circulating normally through the heart’s chambers and valves or through blood vessels near the heart. They can be common during infancy and childhood and often disappear by adulthood.
| Characteristic | Innocent Murmur | Pathological Murmur | Significance |
|---|---|---|---|
| Heart Structure | Completely normal | Structural abnormality | Key differentiator |
| Symptoms | None | May have symptoms | Clinical assessment |
| Intensity | Soft, usually grade 1-3/6 | Variable, often louder | Grading system 1-6 |
| Position Changes | Often position-dependent | Usually unchanged | Functional test |
| Prognosis | Excellent, no health risk | Depends on condition | Risk assessment |
| Treatment | None needed | May require treatment | Management approach |
Reassuring Facts About Innocent Murmurs
Everybody agrees that innocent heart murmur does not carry any morbidity or mortality risk:
- No Disease: Represents normal heart function, not heart disease
- No Symptoms: No associated symptoms or functional limitations
- No Treatment: No medications or procedures required
- No Restrictions: Full participation in all activities and sports
- No Monitoring: Once confirmed innocent, no follow-up needed
- Normal Life: Excellent prognosis with normal life expectancy
Types of Innocent Heart Murmurs
Key insight: Innocent heart murmurs in children can be categorized into four distinct groups: Still’s vibratory murmur, pulmonary flow murmur, supraclavicular systemic flow murmur, and venous hums.
Still’s Vibratory Murmur (Most Common)
Description: By far and away the most common innocent heart murmur, the Still’s murmur is a very unique noise that once heard several times becomes very difficult to confuse with anything else
- Musical, vibratory, low-pitched systolic murmur
- Best heard at left lower sternal border and apex
- Grade 1-3/6 intensity
- Most common age: 3 years to early adolescence
- Loudest when lying down, quieter when sitting/standing
Pulmonary Flow Murmur
Description: Normal blood flow across the pulmonary valve during systole
- Soft, blowing, low-pitched systolic murmur
- Best heard over left upper sternal border
- Grade 1-3/6 intensity
- Most common age: 5-14 years (most common in teenagers)
- May radiate to back and axilla
Cervical Venous Hum
Description: Sound of blood flow returning through neck veins to the heart
- Continuous murmur heard in both systole and diastole
- Best heard in supraclavicular area and neck
- Grade 1-3/6 intensity
- Only heard in sitting/upright position
- Disappears when lying down or with neck compression
Supraclavicular Systemic Flow Murmur
Description: Brief systolic murmur heard above the clavicle
- Brief, low-pitched systolic murmur
- Best heard in supraclavicular fossa
- Grade 1-3/6 intensity
- May radiate to neck
- More prominent in upright position
Age-Related Patterns
In 810 schoolchildren (aged 5-14 years) the prevalence of a grade 1-3/6 vibratory innocent heart murmur is 41%. Restricted to a grade 2 or 3 VIHM, the prevalence is 14%, decreasing from 21% in the age-class 5-6 years to 8% for children 13-14 years of age:
- Early Childhood (3-6 years): Still’s murmur most common
- School Age (5-14 years): Pulmonary flow murmurs peak
- Adolescence: Many murmurs begin to disappear
- Adulthood: Some persist but remain innocent
Causes and Characteristics of Functional Murmurs
Key insight: Functional murmurs are caused by increased blood flow velocity through normal heart structures, often related to high cardiac output states or physiological changes.
| Cause Category | Specific Conditions | Mechanism | Examples |
|---|---|---|---|
| High Output States | Increased cardiac output | Faster blood flow through normal structures | Exercise, fever, anemia, pregnancy |
| Physiological Changes | Normal growth and development | Changing vessel size and flow patterns | Childhood growth spurts, puberty |
| Hyperdynamic Circulation | Increased blood flow velocity | Enhanced cardiac output | Hyperthyroidism, anxiety, caffeine |
| Relative Narrowing | Normal anatomical variations | Temporary flow acceleration | Thin chest wall, false tendons |
| Age-Related | Normal cardiac development | Changing heart size and position | Newborn circulation changes |
Temporary Causes
Conditions that temporarily increase blood flow
- Exercise and physical activity
- Fever and illness
- Pregnancy
- Anxiety or excitement
Medical Conditions
Underlying conditions causing increased flow
- Anemia (low red blood cell count)
- Hyperthyroidism
- Arteriovenous malformations
- Dehydration
Developmental
Normal growth and developmental changes
- Rapid linear growth periods
- Thin chest wall in children
- Normal anatomical variations
- Newborn circulation adaptation
Position and Activity Effects
Functional murmurs are often position-dependent, with murmurs heard while supine and may disappear when upright or sitting:
- Supine Position: Murmurs often louder due to increased venous return
- Standing/Sitting: Many murmurs become quieter or disappear
- Exercise: May temporarily make murmurs more audible
- Valsalva Maneuver: Typically decreases innocent murmur intensity
- Deep Inspiration: May affect timing and intensity of certain murmurs
Medical Evaluation and Diagnosis
Key insight: Innocent murmurs are usually diagnosed based on characteristic sounds and clinical examination, though additional testing may be performed to rule out structural heart disease.
Clinical Criteria for Innocent Murmurs
- Asymptomatic Patient: Otherwise healthy individual, no concerns about growth, no symptoms of heart failure
- Soft Intensity: Soft, less than 3/6 in intensity
- Systolic Timing: Occurs during systole or continuously during both systole and diastole
- Position Dependent: Often position-dependent, heard while supine and may disappear when upright
- No Thrill: No palpable thrill (vibration caused by turbulent blood flow)
- Normal Heart Sounds: Physiologic splitting of S2 components should only be resolvable during inspiration
- Normal Growth: Normal development and no signs of heart failure
- No Associated Symptoms: No chest pain, shortness of breath, or exercise intolerance
Initial Clinical Assessment
Primary Evaluation: Comprehensive history and physical examination
- Detailed family and medical history
- Assessment of symptoms and functional capacity
- Complete cardiovascular examination
- Evaluation of murmur characteristics
Additional Testing (If Indicated)
Confirmatory Studies: Some harmless murmurs require additional tests such as an electrocardiogram (ECG) or echocardiogram (echo) to rule out the possibility of a problem
- Electrocardiogram (ECG/EKG)
- Echocardiogram (cardiac ultrasound)
- Chest X-ray (if indicated)
- Exercise stress testing (rarely needed)
Confirmation of Innocent Nature
Final Assessment: Documentation that murmur is indeed innocent
- Normal cardiac structure on echo
- Normal cardiac function
- No evidence of heart disease
- Clinical correlation with innocent pattern
When No Further Testing is Needed
Many innocent murmurs can be confidently diagnosed clinically without additional testing:
- Classic characteristics of known innocent murmur types
- Completely asymptomatic patient
- Normal growth and development
- No family history of serious heart disease
- Experienced clinician comfortable with diagnosis
- Position-dependent murmur that disappears when standing
Life Insurance Impact and Underwriting
Key insight: Functional heart murmurs are not considered serious conditions and could have little to no effect on life insurance qualifications, with many applicants qualifying for preferred rates.
Minimal Impact
Innocent murmurs typically have little to no effect on life insurance premiums
- Standard to preferred rates common
- No activity restrictions
- Normal life expectancy
- Benign condition
Documentation Key
Proper medical documentation confirming innocent nature is essential
- Echocardiogram preferred
- Clinical evaluation records
- Cardiology consultation
- No underlying heart disease
Carrier Variation
Different insurance companies may have varying requirements
- Some require echocardiogram
- Others accept clinical diagnosis
- Individual assessment
- Multiple applications advisable
| Murmur Status | Documentation Level | Typical Rating | Special Considerations |
|---|---|---|---|
| Confirmed innocent by echo | Comprehensive | Preferred to Standard Plus | Best possible outcome |
| Clinical diagnosis only | Basic | Standard Plus to Standard | May need additional testing |
| Childhood murmur, resolved | Historical | Standard (no impact) | Remote history |
| Recently discovered | Pending evaluation | Postponed until evaluated | Needs medical clearance |
| Uncertain classification | Incomplete | Individual assessment | Additional testing required |
Insurance Company Perspective
Innocent or functional heart murmurs are not considered to be serious conditions and could have little to no effect on life insurance qualifications:
- Low Risk: No increased mortality risk associated with innocent murmurs
- Normal Function: Heart structure and function completely normal
- No Progression: Will not develop into serious heart disease
- No Treatment: No medications or procedures required
- Full Activity: No lifestyle or activity restrictions needed
- Benign Prognosis: Excellent long-term outlook
Required Documentation for Insurance
Key insight: Life insurance companies will want to see that the murmur was confirmed by appropriate medical evaluation, preferably including an echocardiogram, to be innocent.
Essential Medical Records
- Initial Discovery: Records from when murmur was first detected
- Clinical Evaluation: Physician notes describing murmur characteristics
- Diagnostic Testing: Echocardiogram results showing normal heart structure
- Cardiology Consultation: Specialist evaluation confirming innocent nature
- Symptom Assessment: Documentation of absence of cardiac symptoms
- Functional Capacity: Normal exercise tolerance and activity level
- Follow-up Care: Any subsequent evaluations or monitoring
- Family History: Relevant cardiac family history assessment
Gold Standard Documentation Package
- Comprehensive Echocardiogram: Many life insurance carriers will want to see that the murmur was confirmed by an echocardiogram to be innocent
- Cardiology Report: Specialist confirmation of innocent nature
- Clinical Correlation: Physical exam findings consistent with innocent murmur
- Normal ECG: If performed, showing normal electrical activity
- Symptom Documentation: Confirmation of asymptomatic status
- Activity Assessment: Full participation in activities without limitations
- Current Status: Recent evaluation confirming stable, innocent nature
Documentation Timing Considerations
Insurance companies prefer recent medical evaluations:
- Recent Evaluation: Within 2-3 years is ideal for current assessment
- Childhood Diagnosis: Adult confirmation may be helpful for long-standing murmurs
- Complete Records: All relevant medical records from discovery to current
- Consistent Findings: Documentation showing stable, innocent characteristics over time
- No Changes: Evidence that murmur characteristics haven’t changed concerning direction
Expected Rates and Coverage Options
Key insight: Most applicants with properly documented innocent murmurs can expect to receive favorable life insurance rates, often qualifying for preferred or standard plus classifications.
Preferred Plus/Preferred
Best rates for well-documented innocent murmurs with comprehensive evaluation
- Echo-confirmed innocent murmur
- Cardiology clearance
- No other health issues
- Excellent overall health
Standard Plus/Standard
Common rating for innocent murmurs with adequate documentation
- Clinical diagnosis of innocent murmur
- Normal heart function
- Asymptomatic status
- Good overall health
Postponement
Temporary delay for murmurs requiring further evaluation
- Recently discovered murmur
- Incomplete medical evaluation
- Awaiting specialist consultation
- Need for additional testing
| Scenario | Documentation | Expected Rating | Comments |
|---|---|---|---|
| Echo-confirmed innocent murmur | Complete | Preferred to Standard Plus | Ideal scenario |
| Cardiology-confirmed innocent | Comprehensive | Preferred to Standard Plus | Excellent documentation |
| Clinical diagnosis, asymptomatic | Basic | Standard Plus to Standard | May need additional testing |
| Childhood murmur, adult evaluation | Historical + current | Standard Plus to Standard | Continuity important |
| Recently discovered, pending workup | Incomplete | Postponement | Complete evaluation first |
| Unclear classification | Uncertain | Individual assessment | May need declination |
Rate Optimization Factors
If you have an innocent heart murmur, or a murmur which is not the result of another health condition, you can expect to receive a Standard Plus or Preferred health class rating:
- Comprehensive Documentation: Complete medical evaluation with echo confirmation
- Specialist Confirmation: Cardiology evaluation supporting innocent diagnosis
- Asymptomatic Status: No cardiac symptoms or functional limitations
- Normal Activities: Full participation in sports and activities
- Stable Characteristics: Consistent innocent murmur features over time
- Overall Health: Excellent general health status
- Carrier Selection: Choosing companies with favorable murmur underwriting
Application Strategy and Best Practices
Key insight: Success with life insurance applications for functional heart murmurs depends on proper documentation, timing, and working with experienced agents who understand cardiac underwriting.
Pre-Application Preparation
Documentation Gathering: Collect all relevant medical records before applying
- Obtain complete medical records from discovery to present
- Ensure echocardiogram results are available
- Get written confirmation of innocent diagnosis
- Gather any cardiology consultation reports
Medical Evaluation Timing
Current Assessment: Ensure recent medical evaluation if needed
- Recent evaluation within 2-3 years preferred
- Update any outdated testing if necessary
- Confirm murmur characteristics remain innocent
- Document continued asymptomatic status
Application Submission
Strategic Approach: Apply with carriers known for favorable cardiac underwriting
- Work with experienced agents familiar with cardiac cases
- Target multiple carriers with different underwriting approaches
- Provide complete documentation upfront
- Be fully honest about all medical history
Follow-up and Optimization
Post-Application: Monitor progress and optimize outcomes
- Respond promptly to any underwriter requests
- Provide additional clarification if needed
- Consider appeals if initial decision unfavorable
- Compare offers from multiple carriers
Application Best Practices
- Full Disclosure: Complete honesty about murmur and all medical history
- Comprehensive Records: Provide all relevant medical documentation
- Professional Guidance: Get the right information up front and provide the right information to your underwriting expert
- Multiple Applications: Apply to several carriers given varying underwriting approaches
- Timing Consideration: Apply when medical evaluation is current and complete
- Specialist Carriers: Target companies with experience in cardiac cases
- Agent Selection: Work with independent agents with access to multiple carriers
- Patience: Allow adequate time for thorough underwriting review
Common Application Challenges
Potential issues to address proactively:
- Incomplete Documentation: Missing echo or specialist reports
- Uncertain Classification: Murmur not clearly documented as innocent
- Historical Gaps: Missing records from initial discovery
- Recent Discovery: Murmur found during application process
- Carrier Variation: Different companies requiring different documentation levels
- Medical Exam Findings: Murmur discovered during insurance medical exam
Success Factors
Elements that improve application outcomes:
- Clear Diagnosis: Unambiguous documentation of innocent nature
- Specialist Confirmation: Cardiology evaluation supporting benign diagnosis
- Comprehensive Testing: Echocardiogram showing normal heart structure
- Symptom Documentation: Clear evidence of asymptomatic status
- Functional Assessment: Normal exercise tolerance and activity participation
- Consistent Findings: Stable murmur characteristics over time
- Professional Presentation: Well-organized, complete application package
Frequently Asked Questions
Will having a functional heart murmur affect my life insurance rates?
In most cases, no. Functional or innocent heart murmurs are not considered serious conditions and could have little to no effect on life insurance qualifications. Many applicants with properly documented innocent murmurs qualify for preferred or standard plus rates.
Do I need an echocardiogram to get life insurance with a heart murmur?
While not always required, many life insurance carriers prefer to see that the murmur was confirmed by an echocardiogram to be innocent. An echo provides definitive proof that heart structure is normal, which can help secure the best possible rates.
What if my heart murmur was diagnosed in childhood?
Childhood murmurs that were properly evaluated and deemed innocent typically have no impact on adult life insurance applications. However, some carriers may prefer recent adult confirmation that the murmur remains innocent, especially if significant time has passed.
Can I get preferred rates with a functional heart murmur?
Yes, if you have an innocent heart murmur with no other health conditions and comprehensive medical documentation, preferred rates are possible with several insurers. The key is having proper documentation confirming the murmur’s innocent nature.
What if my murmur was discovered during the insurance medical exam?
If a murmur is discovered during your insurance medical exam, the underwriting process may be postponed until you can obtain proper medical evaluation to determine if the murmur is innocent or requires further investigation.
How long do I need to wait after diagnosis before applying?
If your murmur has been properly evaluated and confirmed as innocent, you can typically apply immediately. However, if the murmur was recently discovered and requires additional testing, you may need to wait until the evaluation is complete.
Do all insurance companies treat heart murmurs the same way?
No, different insurance companies have varying underwriting guidelines for heart murmurs. Some may require more extensive documentation while others are more lenient. This is why working with an independent agent who can access multiple carriers is beneficial.
What if I have other health conditions along with my innocent murmur?
If you’re healthy aside from the heart murmur, insurance companies will look on you more favorably. However, if you have other health issues, your overall health class will be determined by the combination of all conditions, with the innocent murmur typically having minimal additional impact.
Ready to Explore Your Life Insurance Options?
Having a functional heart murmur shouldn’t prevent you from securing excellent life insurance coverage at competitive rates. Our cardiac specialists understand how to present innocent murmurs to insurance companies and can help you access carriers that offer the most favorable underwriting for your situation.
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