Pulm heard a loud heart murmur on left side 1 mo ago. Echo norm. Dr says still loud but prob just pleural rub. Can hear in back and up to neck. Chest pain. Sleep sitting up cause hard to breathe and painful. Does norm echo rule out cardiac issues?

Murmur. Was the echocardiogram perfectly normal or was there some valvular abnormality? Sometimes minor abnormalities create loud murmurs. Other causes of loud noises in the chest and neck include abnormalities of blood vessels in the neck or thorax or pericardial disease. Asymmetric septal hypertrophy of the heart can cause loud murmurs but should be obvious on echocardiogram. See a cardiologist for advi.
Murmur. . If the doctor heard a murmur, but the echocardiogram was normal, there could be two main possibilities. First, it could simply be a physiologic murmur which is of no pathologic consequence. Second, the echocardiogram was not sensitive enough to pick up the reason for the murmur. Regardless, you may want to follow up with the cardiologist to be safe.