True or False: A Heart Murmur Is Similar To A Rocky River

At the recent Society of Thoracic Surgeons conference, I was fortunate to reconnect with Dr. Junaid Khan, MD, the Director of Cardiovascular Services at Alta Bates Summit Medical Center in Oakland, California. During our discussion, Dr. Khan shared an interesting analogy about heart murmurs that I felt was really helpful for patients.

In this video, you will learn a lot about heart murmurs — causes, progression, risks and treatment. You will also learn how heart murmurs are somewhat similar to a rocky river.



I hope this video helped you learn more about heart murmurs. Thanks to Dr. Khan for sharing his analogies and clinical experience with our patient and caregiver community.

Keep on tickin!

P.S. Here is a written transcript of my interview with Dr. Khan:

Dr. Khan: My name is Doctor Junaid Khan. I am a cardiac surgeon in Oakland, California. I have been in practice about 15 years. I have done over 10,000 heart surgery operations in my career. Of those, thousands have been minimally invasive valve operations.

Adam Pick: Hi everybody, it is Adam with I am thrilled to be here with Dr. Junaid Khan. What attracted you to the field of cardiac surgery?

Junaid Khan, MD: Well you know, I have been attracted to it for a long time. When I was in 8th grade, my dad took me to an animal lab in UCLA. We got to see a heart actually beating. And he gave different drugs, and the heart beat faster, beat slower and I thought it was the most amazing thing I have ever seen.



Adam Pick: What is a heart murmur?

Dr. Khan: A heart murmur is irregular flow of the heart. The best analogy is most people have seen a river. When the river is nice and smooth,  you hardly ever hear it, the silence. However when it hits a rock but when it goes through a tributary, all of a sudden you hear a lot of noise. Well with that rock in the middle is really what a murmur is. If the valve is blocked or the blood is going backwards you hear that murmur just like you would hear the rapids in a river.

Adam: Dr. Khan, what causes a heart murmur?

Junaid Khan, MD: Most common cause is really are/a blockage in a valve  like an aortic valve, either due to calcium or just sort of over a period of time the valve degenerates and it becomes blocked. Accelerated flow through that valve will actually cause the murmur or the abnormal sound. In the mitral it is usually the other way around. What happens is either the mitral valve is like two trapped doors, there is some hinges. Either the hinge will break and also the valves would start leaking. That leakage is what would cause the murmur.

Adam Pick: Can heart murmurs be harmful to the patient?

Doctor Khan: You know, when you have a heart murmur, it is something you want to have your  doctor checked out. Some heart murmurs can really be quite benign. People have known their heart murmurs all their lives. They just need to be followed. A new heart murmur surely needs to be checked out by your doctor because it could require surgery.

Adam: Do you specialize in any type of heart valve surgery?

Doctor Khan: The only thing that I am most interested in is minimally invasive heart surgery. I do both aortic valve surgery and minimally invasive mitral repair.

Adam Pick: We talk about minimally invasive, we typically think the sternotomy is significant sized incision. What are the incision sizes that you make when you do a minimally invasive procedure?

Junaid Khan, MD: I think that is the key difference. Because I think most people think about a sternotomy. That is how most operations are done in the United States but it really disrupts the chest wall and patients are out for a long time. What we do is we make a small incision in the right chest under the right breast for the mitral, above the right breast for the aortic and with that small incision, we can repair the mitral valve and replace the aortic valve. The real advantage of that is, the patients actually get back to their activities of daily living much sooner. They  drive, play golf, whatever they want to do much sooner.


Dr. Khan – Heart Surgeon


Adam Pick: Are heart murmurs medically or surgically treated?

Junaid Khan: A heart murmur by itself really needs to be further delineated as to what is causing the murmur. Some murmurs really require no attention whatsoever except follow-up. Some require urgent surgery. So it is really an expert looking at the murmur, looking at an ultrasound of the heart  to decide what needs to be done.

Adam Pick: For all the patients out there who have been diagnosed with a heart murmur, what would you say are your top pieces of advice for them?

Dr. Khan: You know, the most important advice I have for patients that have a heart murmur is to have it checked out. And patients who have severe murmurs and actually severe leakage, they really need surgery sooner rather than later. I think the biggest mistakes some of these patients made particularly with mitral regurgitation, is they are actually feeling fine and they tell themselves, “I am going to wait till I am sick before I have surgery.” That is the wrong answer. You  want to have surgery before you get sick, if you have severe leakage.

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of

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