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Approach to the infant or child with a cardiac murmur

Robert L Geggel, MD
Section Editors
David R Fulton, MD
Martin I Lorin, MD
Deputy Editor
Carrie Armsby, MD, MPH


Heart murmurs are common in infants and children. Evaluation of a murmur is the most common reason for referral to a pediatric cardiologist [1,2]. While the prevalence of congenital heart disease is approximately one percent, a majority of children have innocent murmurs at some time [3,4]. Being able to distinguish a murmur associated with heart disease from a benign etiology is important for diagnosis and management (table 1). (See 'Distinguishing pathologic from innocent murmurs' below.)

The approach to the infant or child with a cardiac murmur will be reviewed here. Common causes of heart murmurs in childhood, the approach to identifying newborns with critical heart disease, and the approach to evaluating children with suspected heart disease are discussed separately:

(See "Overview of common causes of cardiac murmurs in infants and children".)

(See "Identifying newborns with critical congenital heart disease".)

(See "Suspected heart disease in infants and children: Criteria for referral".)

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Literature review current through: Dec 2017. | This topic last updated: Jun 01, 2017.
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  1. Abdurrahman L, Bockoven JR, Pickoff AS, et al. Pediatric cardiology update: Office-based practice of pediatric cardiology for the primary care provider. Curr Probl Pediatr Adolesc Health Care 2003; 33:318.
  2. Pelech AN. Evaluation of the pediatric patient with a cardiac murmur. Pediatr Clin North Am 1999; 46:167.
  3. McLaren MJ, Lachman AS, Pocock WA, Barlow JB. Innocent murmurs and third heart sounds in Black schoolchildren. Br Heart J 1980; 43:67.
  4. Danford DA, McNamara DG. Innocent murmurs and heart sounds. In: The Science and Practice of Pediatric Cardiology, 2nd ed, Garson AJ, Bricker JT, Fisher DJ, Neish SR (Eds), Williams & Wilkins, Baltimore 1998. p.2204.
  5. Geggel RL, Fyler DC. History, growth, nutrition, physical examination, and routine laboratory tests. In: Nadas' Pediatric Cardiology, 2nd ed, Keane JF, Lock JE, Fyler DC (Eds), Saunders, Philadelphia 2006. p.129.
  6. Geggel RL. The cardiac examination. In: Comprehensive Pediatric Hospital, Zautis LB, Chiang VW (Eds), Mosby, Philadelphia 2007. p.513.
  7. French JW, Guntheroth WG. An explanation of asymmetric upper extremity blood pressures in supravalvular aortic stenosis: the Coanda effect. Circulation 1970; 42:31.
  8. CELORIA GC, PATTON RB. Congenital absence of the aortic arch. Am Heart J 1959; 58:407.
  9. Marino BS, Goldblatt A. Heart sounds and murmurs. In: Pathophysiology of Heart Disease, Lilly LS (Ed), Lea & Febiger, Philadelphia 1992. p.18.
  10. Duff DF, McNamara GG. History and physical examination of the cardiovascular system. In: The Science and Practice of Pediatric Cardiology, 2nd ed, Garson AJ, Bricker JT, Fisher DJ, Neish SR (Eds), Williams and Wilkins, Baltimore 1998. p.693.
  11. Perloff JK. Heart sounds and murmurs: physiologic mechanisms. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, Braunwald E (Ed), Saunders, Philadelphia 1992. p.43.
  12. Freeman AR, Levine SA. The clinical significance of the systolic murmur. A study of 1,000 consecutive "non-cardiac" cases. Ann Intern Med 1933; 6:1371.
  13. Still GF. Common disorders and diseases of childhood, Henry Growde (Ed), London 1909.
  14. Frank JE, Jacobe KM. Evaluation and management of heart murmurs in children. Am Fam Physician 2011; 84:793.
  15. Kang G, Xiao J, Wang Y, et al. Prevalence and clinical significance of cardiac murmurs in schoolchildren. Arch Dis Child 2015; 100:1028.
  16. McCrindle BW, Shaffer KM, Kan JS, et al. Cardinal clinical signs in the differentiation of heart murmurs in children. Arch Pediatr Adolesc Med 1996; 150:169.
  17. Etoom Y, Ratnapalan S. Evaluation of children with heart murmurs. Clin Pediatr (Phila) 2014; 53:111.
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