title: Heart murmurs in pediatric patients: when do you refer?
abstract: Many normal children have heart murmurs, but most children do not have heart disease. An appropriate history and a properly conducted physical examination can identify children at increased risk for significant heart disease. Pathologic causes of systolic murmurs include atrial and ventricular septal defects, pulmonary or aortic outflow tract abnormalities, and patent ductus arteriosus. An atrial septal defect is often confused with a functional murmur, but the conditions can usually be differentiated based on specific physical findings. Characteristics of pathologic murmurs include a sound level of grade 3 or louder, a diastolic murmur or an increase in intensity when the patient is standing. Most children with any of these findings should be referred to a pediatric cardiologist.
authors.affiliation: Division of Pediatric Cardiology, East Carolina University School of Medicine, Greenville, North Carolina 27858-4354, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: McConnell
authors.forename: S B
authors.initials: SB
authors.lastname: Adkins
authors.forename: D W
authors.initials: DW
authors.lastname: Hannon
mesh_terms: D001314:Auscultation; D002648:Child; D002675:Child, Preschool; D006337:Heart Murmurs / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D010173:Palpation; D010353:Patient Education as Topic; D012017:Referral and Consultation; D013664:Teaching Materials