If you’re a runner, you already know the drill: push too hard, and your body will send you signals.
Tight calves, sore knees, a lingering fatigue that doesn’t shake off.
But what happens when the warning sign isn’t in your legs—it’s in your chest?
Hearing the words “you have a heart murmur” can stop any athlete in their tracks.
It sounds scary, almost like your heart is broken.
But here’s the truth most people don’t realize: a murmur isn’t a disease—it’s a sound.
A signal.
Sometimes it’s harmless background noise; other times, it’s your body waving a red flag.
In this post, I’ll break down what heart murmurs really are, why they happen, and most importantly, what they mean for your running.
Whether you’re training for your first 5K or your tenth marathon, you’ll walk away knowing when to shrug it off—and when to take action.
What Is a Heart Murmur?
A heart murmur is just an extra sound your heart makes—kind of like a soft whoosh or swish—when blood flows through it.
It doesn’t always mean something is wrong.
Think of it like water flowing through a narrow section of a pipe—it might gurgle or hiss a bit.
That’s what your heart might be doing. What matters isn’t the sound itself, but why it’s happening.
Here are the two types:
1. Innocent (Functional) Murmurs
These are common, harmless, and nothing to stress over.
The heart’s structure is totally normal.
Sometimes blood flows a little faster than usual—due to exercise, fever, anemia, stress, or pregnancy—and that causes the extra sound.
Fact: About 30% of kids and 1 in 10 adults have an innocent murmur at some point
. Most don’t even know they have one.
2. Abnormal (Pathological) Murmurs
These are tied to a structural issue inside the heart—like a tight valve, a leaky valve, or a hole between chambers.
Some conditions are minor and manageable (like mitral valve prolapse), while others need close monitoring or treatment.
How Doctors Tell the Difference
First, they listen with a stethoscope.
Then, they may order an echocardiogram—an ultrasound of your heart—to look at valves, chambers, and blood flow.
If the echo comes back normal, your murmur is likely innocent.
You probably don’t need treatment—and yes, you can keep running.
When to Worry: Red Flags for Runners
Innocent murmurs usually cause no symptoms.
But if you feel off, and your doctor hears a murmur, take it seriously.
Here are signs something more serious might be going on:
- Chest pain or tightness, especially during or after runs
- Shortness of breath at rest or during light activity
- Dizziness or fainting (especially mid-run or after exertion)
- Heart palpitations or a fluttering/racing feeling in your chest
- Swollen ankles or neck veins
- Blue lips or fingertips (a sign of poor oxygen circulation)
- A lingering cough or drenching sweats with minimal effort
- New or extreme fatigue—struggling with distances that used to be easy
These symptoms, paired with a murmur, are not normal runner fatigue.
They can be signs of valve disease or more serious issues like hypertrophic cardiomyopathy (HCM), aortic stenosis, or other heart conditions that demand medical attention.
Coach’s rule of thumb: If your murmur comes with strange symptoms, stop guessing and go get checked.
Running with a Heart Murmur: What Runners Need to Know
Let’s get one thing straight: a heart murmur doesn’t automatically sideline you from running.
But it does deserve your attention—especially if it comes with symptoms.
I’ve read about runners with murmurs who train pain-free, race hard, and live full athletic lives.
Others needed a pause, some tests, and treatment before coming back stronger.
The key? Know your type, listen to your body, and get medical clearance.
First Rule: If Something Feels Off, Don’t Tough It Out
New symptom you can’t explain? Dizziness, chest tightness, fainting—even once? Get checked.
One runner ignored lightheaded spells and chalked it up to training fatigue. Turned out he had hypertrophic cardiomyopathy. Catching it early may have saved his life.
Pain or passing out mid-run is never “just dehydration.” It’s your body waving a red flag. You wouldn’t ignore a searing pain in your knee—don’t ignore your heart.
So, Can You Run with a Heart Murmur?
Quick answer: Yes—if it’s an innocent murmur and your doctor clears you.
An innocent murmur is basically a harmless sound your heart makes as blood moves through it.
It’s common, even among elite athletes, and it doesn’t affect performance.
- Structure and function = normal
- No impact on endurance or heart strength
- Exercise is actually encouraged
The American Heart Association is clear: if your murmur is truly innocent, there’s no need to limit activity.
When a Murmur Could Be a Problem
Not all murmurs are innocent. Sometimes, they’re a symptom of a bigger issue—like:
- Aortic stenosis (narrowed valve = limited blood flow during exertion)
- Hypertrophic cardiomyopathy (HCM) (thickened heart muscle, risk of arrhythmia)
- Valve defects (may require surgery or management)
These conditions don’t mean you’ll never run again—but they do mean you need to be smart and get evaluated before logging serious miles.
Get Cleared First – Especially With a New Diagnosis
If you’ve just found out you have a murmur (or have had one for years but never got it looked at properly), book that cardiology visit.
Most doctors will:
- Run an echocardiogram
- Possibly do a stress test or ECG
- Confirm whether the murmur is harmless or not
This is a one-time safety check that can save you from training through something serious.
Sports cardiology guidelines are clear: any new murmur in an athlete should be checked before continuing high-intensity exercise.
Real-Runner Story: Hiba’s Detour
Marathoner Hiba Jelahej was in peak shape—but began feeling dizzy and fainting during workouts.
Turns out she had a rare valve defect behind a murmur no one knew about.
She underwent surgery and rehab, then slowly returned to running—starting with a mile, then building up.
Her takeaway? Listen to your body, ask questions, and keep moving forward—even if the pace changes for a while.
Heart Murmur in Athletes: Why It’s More Common Than You Think
If your doctor ever tells you, “You’ve got a heart murmur,” it can sound scary—like something’s wrong.
But here’s the truth: in athletes, especially endurance runners, heart murmurs are surprisingly common—and often harmless.
In fact, they can be a byproduct of a strong, well-trained heart.
Let’s break it down.
“Athlete’s Heart” and Innocent Murmurs
When you train consistently—logging miles week after week—your heart adapts.
It gets stronger. The chambers (especially the left ventricle) may slightly enlarge. It pumps more blood per beat.
That’s called athlete’s heart, and it’s a normal physiological change.
But with more blood pumping through a bigger engine, the flow can sound turbulent or louder to a doctor’s stethoscope.
That whooshing noise? It’s often just the sound of vigorous, healthy blood flow. This is known as a flow murmur or innocent murmur.
One study found that around 50% of people exercising 5+ hours a week showed some degree of heart chamber enlargement. That’s not disease—that’s adaptation.
So if your doctor hears a murmur, and you’re a fit runner, there’s a solid chance it’s just your heart doing its job—better than average.
When It Shows Up
Most runners discover a murmur during a sports physical, race clearance, or routine checkup.
The conversation usually goes like this:
“You have a murmur, but everything else looks great.”
At that point, your doctor may order an ECG or echocardiogram to be safe.
Good call. It’s not overkill—it’s smart screening to confirm that what they’re hearing is functional, not pathological.
Sometimes, It’s a Sign of Better Performance
Believe it or not, a murmur in a trained runner can sometimes indicate enhanced cardiac function.
- Your resting heart rate drops
- Stroke volume increases
- The left ventricle may enlarge slightly
- Blood whooshes through faster = audible murmur
This is why some coaches call it the “sound of a strong heart.”
Not medically accurate, sure—but it’s a reminder that murmurs aren’t always red flags. Often, they’re just signals of an efficient cardiovascular system.
These are called functional murmurs—soft, usually systolic, and often disappear when you’re at rest.
When to Take It Seriously
Still, a murmur isn’t something to ignore. Most are innocent—but some aren’t, and you don’t want to miss the serious ones.
When to dig deeper:
- You feel dizzy, faint, or overly winded during runs
- There’s a family history of heart disease or sudden cardiac events
- The murmur sounds abnormal or persists during rest
- Your doctor suggests follow-up
In these cases, get checked. An ECG or echocardiogram can rule out things like:
- Valve defects
- Hypertrophic cardiomyopathy (HCM)
- Congenital abnormalities
And if something does show up? Good. You caught it.
That’s the whole point of screening. Some athletes have literally saved their lives by catching a murmur early and following through.
Running with a Heart Murmur: Your Safety Checklist
So, you’ve got a heart murmur — and you still want to run.
Good. In most cases, you can.
But you’ve got to be smart about it.
Here some of the things you need to do according to my research:
1. Talk to a Cardiologist — Get the Full Picture
This isn’t something to Google-and-guess. Find out: is your murmur innocent (harmless), or tied to a heart condition? That usually means getting an echocardiogram and maybe an ECG.
Know what’s causing the murmur — is it just increased blood flow, or a valve issue that needs monitoring?
Don’t run blind. Get clarity — and get it from a specialist.
2. Know Your Family History
Heart problems often run deep. If someone in your family had sudden cardiac issues, valve defects, or even unexplained fainting, bring that up.
Some conditions are genetic (like hypertrophic cardiomyopathy), and it’s better to catch that early than after something goes wrong on a run.
3. Get Cleared — And Get Specifics
Once your cardiologist gives the all-clear, ask what your actual limits are. Can you do intervals? Long runs? Should you cap your heart rate?
Tip: Get your clearance in writing if you’re part of a running club or school program. Coaches will appreciate the clarity.
4. Train by Heart Rate — Not Just Feel
If you’ve got a heart murmur, training smart = training within your limits.
That might mean keeping your HR below a certain number (e.g., 150 bpm) or staying out of Zone 5 completely.
Use a chest strap or good-quality fitness watch. Don’t guess.
5. Respect the Environment
Heat, humidity, and altitude all jack up your heart’s workload. If the weather’s brutal, swap your workout for a cooler time or take it indoors.
And hydrate like it’s your job — dehydration puts extra strain on your heart, especially if your murmur is flow-related.
6. Watch for Warning Signs
You know your body. If you start feeling:
- Dizziness
- Chest tightness
- Fluttering
- Extreme shortness of breath
STOP. That’s not “mental toughness” — that’s your heart saying “pull the plug.”
7. Schedule Yearly Checkups
Even if your murmur is harmless now, things can change. Get a checkup at least once a year.
If you’ve got a valve issue, your doc may want an echo every 12–24 months. Stay ahead of it.
8. Reassess If Symptoms Pop Up
If you’ve been running fine and suddenly you’re not — don’t ignore that. A murmur that was stable can shift.
New symptoms? Get checked. Don’t wait for your annual visit.
9. Support Your Heart Outside of Running
The usual stuff applies — eat well, sleep enough, manage stress. That’s not fluff.
Sleep is when your body repairs. Good nutrition supports heart tissue and recovery.
And chronic stress can trigger arrhythmias or spikes in blood pressure.
So yeah — chill matters.
10. Keep Running (if your doctor says it’s safe)
Running is actually good for your heart, murmur or not. Aerobic fitness improves circulation, helps control blood pressure, and can even slow down the progression of some heart conditions.
As one cardiologist said to a client of mine:
“I’d rather you run carefully than sit on the couch in fear.”
Just don’t wing it. Respect the limits your doctor sets and stick to them.
With a smart plan, most runners with murmurs do just fine — and some even come back stronger because they train more intentionally.
Treatment & Management of Heart Murmurs
It’s Not About the Murmur—It’s About What’s Causing It
Let’s get this straight: a heart murmur isn’t the problem. It’s a symptom. A sound. What actually matters is why it’s happening.
So before you panic or Google yourself into cardiac dread, here’s how the treatment breakdown works.
1. Innocent (Benign) Murmurs: Nothing to Fix
If your doc says it’s an innocent murmur, you’re in the clear. Your heart’s structurally normal. You don’t need meds. You don’t need surgery. You don’t need to quit running.
You just… live your life.
Your doc might jot it down in your file and recommend routine physicals, but that’s it. In fact, many of these murmurs:
- Disappear with age (especially in kids)
- Show up when you’re dehydrated, anemic, or just post-hard run
- Come and go depending on your circulation
Just keep doing the basics: train smart, eat well, stay healthy. You’re good.
2. Abnormal Murmurs: Treat the Root Cause
Now, if the murmur’s due to an actual heart condition, the goal shifts: fix the cause or manage the condition so your heart stays strong.
Here’s how that breaks down based on the source:
- Mild: Usually just monitored. No big changes yet.
- Moderate: You may get meds like beta blockers or ACE inhibitors to reduce strain.
- Severe: Surgery or catheter procedures to repair or replace the valve.
Yes, open-heart surgery sounds terrifying. But sometimes drastic measures have to be taken.
HCM (Hypertrophic Cardiomyopathy)
No cure—but manageable. Common tools:
- Beta blockers or calcium channel blockers to help the heart relax
- Possibly an implantable defibrillator (ICD) as a safety measure
- Modified training plans based on your specific condition
This one takes nuance. Work with a cardiologist who gets athletes.
Holes in the Heart (ASD/VSD)
- Small defects: Often watched, no treatment needed
- Large ones: Closed via surgery or a catheter procedure
Once healed? Most people are cleared for full activity, and the murmur disappears.
Arrhythmias
Sometimes a murmur tags along with heart rhythm issues. If that’s the case:
- Treat the arrhythmia (meds or ablation)
- Fix the rhythm, and often the murmur settles too
Infection (Endocarditis)
If you’ve got a new murmur and a fever, this is a red flag.
- Requires IV antibiotics
- Sometimes surgery if valves are damaged
Recovery depends on severity, but early treatment is everything.
Heart Failure
This one’s complex. Murmurs can come from valves not sealing right or pressure buildup. Management is all-in:
- Meds (beta blockers, ACE inhibitors, diuretics)
- Devices (like pacemakers)
- Possibly transplant in extreme cases
Runners with early-stage heart failure may still train—but under strict medical guidance.
Here are some common medications:
- Beta blockers – slow heart rate, reduce strain. Good for HCM, valve issues.
- ACE inhibitors/ARBs – lower BP, ease heart workload.
- Diuretics – reduce fluid if you’re swelling or short of breath.
- Statins – protect arteries if you’ve got high cholesterol or risk factors.
- Anticoagulants (aspirin, warfarin) – prevent clots, especially in valve issues or atrial fibrillation.
- Antibiotics before dental work? Rare these days, but still used for high-risk valve patients. Follow your cardiologist’s lead.
Surgery: Last Resort, but Often a Game Changer
Surgery sounds scary.
But for the right person, it’s life-changing.
- Valve repairs/replacements
- Fixing holes (ASD, VSD)
- Septal myectomy for HCM
Modern procedures—even minimally invasive ones—have helped countless athletes get back to what they love.
Lifestyle Adjustments for Runners with Heart Murmurs
If you’ve been diagnosed with a heart murmur—whether it’s innocent or tied to something deeper—there are some lifestyle levers you can pull to protect your heart and keep running safely.
None of this is about panic. It’s about running smarter.
Some of the changes include:
- Cut the sodium if you’ve got high blood pressure or heart failure
- Dial back the caffeine if you’ve got an arrhythmia (too much can trigger irregular beats)
- No smoking—ever. If your heart has issues, smoking will make every one of them worse
- Limit alcohol—especially binge drinking, which can lead to rhythm problems
- Watch your weight—carrying extra pounds forces your heart to work harder, especially with valve issues or hypertrophic cardiomyopathy (HCM)
The good news? Running (in moderation) helps with all of these.
FAQs: Running with a Heart Murmur
Is running safe with a heart murmur?
Yes—if you’ve been evaluated. If it’s an innocent murmur, you’re good to go. If it’s tied to a condition, you may just need to modify your intensity or follow-up regularly.
Lots of runners have murmurs and do just fine. Get the green light from your doc, then run smart.
Can exercise cause or worsen a murmur?
Exercise can cause temporary innocent murmurs due to increased blood flow—think of it as a harmless “whoosh” when your heart’s working hard.
For real structural murmurs? Exercise won’t “break” your valve, but if you already have symptoms, going too hard could make those show up faster. That’s why intensity guidance is key.
Can a murmur go away?
Yes:
- Kids often outgrow innocent murmurs
- Murmurs caused by fever, anemia, or hyperthyroid often fade when the issue resolves
- Surgery or treatment for abnormal murmurs can reduce or eliminate the sound
Some murmurs stick around forever—but never cause issues. They just need monitoring.
What tests will I need?
- Echocardiogram (echo) – shows valve structure and function
- Electrocardiogram (ECG) – checks rhythm and heart strain
- Chest X-ray – looks at heart size
- Stress test – evaluates how your heart responds to exercise
- Cardiac MRI or catheterization – only if deeper investigation is needed
Most runners just need echo + ECG to start. From there, your doc can build the right plan.
What heart rate zones should I stay in?
This is personal. But here’s a general breakdown:
- Innocent murmur + healthy heart = full zone access (just build up gradually like any smart runner)
- Underlying issue (like valve disease or HCM) = likely capped at Zone 2–3
- Zone 2 (60–70% HRmax): your safest endurance zone
- Zone 3 (70–80%): steady but not crazy; check with your doc
- Zone 4–5 (80%+): high effort, maybe off-limits depending on your condition
A heart rate monitor is your friend. Know your limits—and listen to your body. If Zone 2 suddenly feels like Zone 4, back off.
Final Thoughts: Run Smart, Not Scared
A heart murmur sounds scary—but in most runners, it ends up being a sidebar, not a stop sign.
The key? Get checked. Understand your condition. Then train accordingly.
We run to feel strong, clear our heads, and take care of ourselves. None of that changes just because your doctor hears a murmur. If anything, now you know more—and that’s power.
“Not every medical condition means you have to stop running—but you do need to understand it.”
When one of my own running buddies got diagnosed with a murmur, it didn’t end his running. It started a conversation—and a smarter training plan. He got cleared, adjusted his workouts, and now he’s running pain-free with more awareness than ever.
Sometimes, what sounds scary is actually a blessing in disguise—a reason to train with more intention, more gratitude, and more respect for the body you’ve got.