Gather appropriate history, family history and perform a physical examination. Concerning elements are age dependent, for example an infant who has excessive sweating while eating is concerning. An adolescent with exercise induced chest pain is concerning. For older children, dynamic assessment of the heart murmur is important (listening to the heart in different positions).
If the patient is asymptomatic with benign family history and has the following characteristics* to the heart murmur then no further cardiac evaluation is needed. The patient has an innocent heart murmur which is a normal variation. If during upcoming evaluations, the characteristics of the heart murmur changes, then please refer to cardiology.
* The Seven “S” of Innocent Murmurs: (Bronzetti et al. Clin Pediatr (Phila). 2010 Jul;49(7):713)
- Systolic (apart from venous hum)
- Small (limited area)
- Soft (low amplitude)
- Single (no clicks or gallops)
- Sweet (never harsh)
- Sensitive (to posture) (does not increase with standing up from sitting or squatting)