Innocent

• readily heard murmur in anatomically noraml heart

• up to 66% of children

• turbulent blood flow

  • cigorous hearts

  • small chest walls

• no cardiovascular symptoms

• soft murmur

  • short systolic

• heart sounds normal

• no radiation to murmur

• no evidence of heart enlargement

• variable intensity

  • only present when febrile

  • altered by change in posture

types

• Pulmonary flow murmur

  • soft, short ESM ULSE

    • no radiation

    • ddx - ASD: splitting of s2

  • Still’s murmur

    • vibratory midsystolic mumur; LLSE

    • ddx VSD: loud pansystolic

  • Venous hum

    • continuous murmur towards neck

    • altered by movements ofneck and reclining

Assessment:

• refer if:

  • any cardiac symptoms

    • sob

    • coloru change

    • sweating

    • poor feeding

    • FTT

  • \<3mo

  • murmur diastolic or loud or radiate posteriorly

  • second heart sound abnormal

  • murmur heard when well as well as when febrile