<s>[INST] I went for a physical to a new doctor.  There was nothing alarming about my physical, but when I told them I have had a heart murmur all my life with no problems, I am age 59, they now want to do a echo.  Is this necessary?    I undertand they are expensive. [/INST] Hi, If murmur is really present then it is advisable to do echocardiography (2DEcho) of heart, though there are no symptoms. Heart murmur are due to-1) Structural defects in  heart like heart valves or any abnormal communication in heart chambers. 2) Abnormalities of blood flow like in severe anemia (low hemoglobin)  called as functional murmur. </s>