50-80% of children have audible heart murmurs at some point in their lives most murmurs are functional (i.e. "innocent"...
- 50-80% of children have audible heart murmurs at some point in their lives
- most murmurs are functional (i.e. "innocent") without associated
structural abnormalities - murmurs can become audible or accentuated in high output states,
e.g. fever
| Innocent | Pathological | |
| history and physical | asymptomatic | symptoms and signs of cardiac disease |
| timing | systolic ejection murmur (except venous hum) | all diastolic, pansystolic or continuous |
| grade | <2/6 | >2/6 |
| splitting | physiologic S2 | fixed splitting or single S2 |
| extra sounds clicks | none | present |
| change of position | murmur varies | unchanged |
Five Innocent Heart Murmurs
| Type | Description | Differential Diagnosis |
| 1.Still's murmur | vibratory, LLSB or apex | subaortic stenosis, small VSD |
| 2.pulmonary ejection | soft, blowing, ULSB | ASD, PS |
| 3.venous hum | infraclavicular hum, continuous, R > L | PDA |
| 4.supraclavicular arterial bruit | low intensity, above clavicles | AS, bicuspid aortic valve |
| 5.peripheral pulmonic stenosis | neonates, low-pitched radiates to axilla and back | PDA, PS |
