My horse has a bad one. Its never caused any problems at all. I thought they were born with them, but perhaps not. And I would imagine like anything else, it could be misdiagnosed
They can be congenital (/hereditary) or acquired so yes it can be developed. Usually due to valvular insufficiency - the swooshing sound is due to turbulence of the bloodflow through the valves or sometimes leakage through the valves (this is often the case in congenital forms). Insufficiency can occur due to infection or neoplasia (cancer). A lot of general infections horses pick up - through aerosols or skin injury can become blood-borne and occasionally can cause infection of heart valves resulting in murmurs. Also neoplasms can interfere with the closure of the valves causing a murmur. These are just a few of the basic causes.
Cant exactly remember, but would think that an acquired murmur due to infection or neoplasia would be more progressive than most congenital murmurs. Iv seen horses pass prepurchase vettings for showjumping/riding club activities and hunting with grade 2 murmurs- of course it is written on the vet cert though.
Edited to say: yes, murmurs certainly can be misdiagnosed - listening to murmurs and variations (inc "normal" variations in heartbeats) takes some getting used to!
One of my oldies had a heart murmur on one MOT but not on the next! No idea why as both times he seemed fine. The other oldie has a heart murmur which is noted every year in his MOT test!!!!
Depends on the murmer. They're quite difficult to hear/diagnose in people sometimes, let alone horses - have you ever listened to a horses heartbeat through a stethoscope?
It may not help, but my son has a flow murmer rather than a structural one. His flow murmer apparently has no consequence. I could dig someone up who has more info if you like - I'm definitely not an echocardiography specialist. As I understand it you need an echo to properly determine whether or not any heard heart murmer is a problem. We had one done on our son when he was very wee because of what the GP heard at a routine weigh and measure clinic.