Heart murmur is a common issue in pediatric patients, but the presence of a murmur does not always indicate the presence of heart disease. Pathologic murmurs include those louder than grade 3, all diastolic murmurs, unusually harsh systolic murmurs, and murmurs associated with clicks or abnormal splitting of S2. A murmur that increases in intensity with standing could indicate hypertrophic cardiomyopathy. Murmurs associated with dysmorphic features should be referred as there is a higher risk of congenital heart disease in syndromic patients. A number of innocent murmurs exist which are described below, and which, in the asymptomatic patient, do not require further evaluation by a pediatric cardiologist.
