Related Experiment Video
Updated: Aug 18, 2026
Measuring Cardiac Autonomic Nervous System (ANS) Activity in Children
Published on: April 29, 2013
[Evaluation of cardiac murmurs in children]
Ansgar Berg1, Gottfried Greve, Asle Hirth
1Barneklinikken, Haukeland Universitetssjukehus, 5021 Bergen.
Insights
Most pediatric heart murmurs are innocent, but clinical evaluation is key. Referral to a pediatric cardiologist is recommended if a murmur is not clearly innocent or if cardiovascular symptoms are present.
Area of Science:
- Pediatric Cardiology
- Clinical Auscultation
- Diagnostic Evaluation
Context:
- Heart murmurs are common in children, with most being benign.
- Distinguishing innocent murmurs from pathological ones is crucial for timely diagnosis and management of pediatric heart disease.
- Clinical assessment remains the primary tool for initial differentiation.
Purpose:
- To review the clinical approach for differentiating innocent pediatric heart murmurs from pathological murmurs.
- To outline criteria for referral to a pediatric cardiologist.
- To emphasize the importance of thorough history and physical examination.
Summary:
- A detailed patient history and physical examination are essential for identifying children at risk for significant heart disease.
- Specific murmur characteristics (sound, intensity, location, response to posture) aid in classifying murmurs.
- Referral to a pediatric cardiologist is indicated for murmurs of uncertain etiology or presence of cardiovascular symptoms.
Impact:
- Facilitates appropriate referral pathways for pediatric patients with heart murmurs.
- Aids clinicians in managing pediatric cardiac conditions effectively.
- Reduces unnecessary anxiety and healthcare costs associated with misdiagnosed pediatric heart murmurs.
Background:
Many normal children have heart murmurs, but most children do not have heart disease. Differentiation of innocent murmurs from those due to structural heart disease, pathological murmurs, is largely clinical.
Material And Methods:
This review is based upon the authors' own studies and PubMed searches.
Results:
An appropriate history and a properly conducted physical examination can identify children at risk of significant heart disease.
Interpretation:
If a murmur cannot clearly be labelled as innocent based on characteristics like sound quality, intensity, location and response to posture, then referral to a paediatric cardiologist is indicated. Other indications for referral are any sign or symptom of cardiovascular disease such as shortness of breath, cyanosis or decreased exercise tolerance. In addition, children with syndromes should, because of their high risk of congenital heart disease, be referred to a paediatric cardiologist for further evaluation.
Related Concept Videos
01:25Cardiovascular System Abnormal Findings II: Auscultation
Abnormal Heart Sounds
Gallops:
01:15Heart Sounds
Auscultation is the process of listening to these internal body sounds using a stethoscope. The heart produces four types of sounds, but only two—S1 and S2—can usually be heard with a stethoscope.
S1, also known as the "lub" sound, is caused by the closure of atrioventricular (A-V) valves at the...
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:25Assessment of the Cardiovascular System IV: Auscultation
Normal Heart Sounds
S1 (First Heart Sound)-
S1 is made by the closure of the mitral and tricuspid valves (atrioventricular valves), marking the beginning of systole.
S2 (Second Heart Sound)-
S2 is made by the closure of the aortic and pulmonic valves (semilunar valves), marking the end of the systole.
01:23Mitral Regurgitation II: Clinical Features and Diagnostic Tests
01:13Special considerations while measuring pulse