Innocent pediatric murmurs - Revision history

Rossdonaldson1: /* Management */

2026-04-15T19:52:23Z

Management

← Older revision		Revision as of 19:52, 15 April 2026
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	==Management==		==Management==
			*By definition, "innocent" murmurs typically require no management

	==Disposition==		==Disposition==

Rossdonaldson1 at 19:49, 15 April 2026

2026-04-15T19:49:23Z

Danbot: Add verified PubMed references (PMIDs 30761241)

2026-03-22T11:00:17Z

Add verified PubMed references (PMIDs 30761241)

← Older revision		Revision as of 11:00, 22 March 2026
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	==Background==		==Background==
	*72% of all school-age children have innocent murmurs		*72% of all school-age children have innocent murmurs<ref>Doshi AR. Innocent Heart Murmur. Cureus. 2018 Dec 5;10(12):e3689. PMID 30761241</ref>
	*[[Congenital heart disease]]- 0.8% of live births		*[[Congenital heart disease]]- 0.8% of live births

Danbot: Add evidence-based Disposition section

2026-03-22T10:04:04Z

Add evidence-based Disposition section

← Older revision		Revision as of 10:04, 22 March 2026
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	==Management==		==Management==

			==Disposition==
			*Discharge with reassurance if:
			**Murmur has classic innocent characteristics (soft, systolic, grade I-II, no radiation)
			**Normal vital signs and growth parameters
			**No concerning associated symptoms (syncope, cyanosis, exercise intolerance)
			**Normal ECG and/or echocardiogram if obtained
			*Refer to pediatric cardiology for:
			**Diastolic murmurs
			**Loud murmurs (grade III or higher)
			**Murmurs with associated symptoms
			**Abnormal ECG findings
			**Murmurs in neonates (consider echocardiography)

	==See Also==		==See Also==

Danbot: Add References section

2026-03-22T09:24:56Z

Add References section

← Older revision		Revision as of 09:24, 22 March 2026
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	*[[Heart Murmurs]]		*[[Heart Murmurs]]
	*[[Valvular Emergencies (Valve)]]		*[[Valvular Emergencies (Valve)]]

			==References==
			<references/>

	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Cardiology]]		[[Category:Cardiology]]

Rossdonaldson1: Rossdonaldson1 moved page Innocent murmurs (peds) to Innocent pediatric murmurs

2019-11-28T23:19:24Z

Rossdonaldson1 moved page Innocent murmurs (peds) to Innocent pediatric murmurs

← Older revision	Revision as of 23:19, 28 November 2019
(No difference)

ClaireLewis at 15:26, 25 September 2019

2019-09-25T15:26:07Z

← Older revision		Revision as of 15:26, 25 September 2019
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	==Clinical Features==		==Clinical Features==
	*~~Check~~ height and weight- left-to-right can cause decrease in weight, but are usually symptomatic		*Goal to distinguish innocent (benign) murmurs from clinically significant pathology
	*Color - cyanosis of hands, feet, perioral on exertion		*Red flag features that may point to pathology, ''not'' innocent murmurs:
	*Feeding - fatigue or short feeding times for infants- perspiring, grunting, coughing, tachycardia while feeding. Severe [[CHF]] may show at rest deep breathing with [[dyspnea]] with distress		**[[Failure to thrive (peds)\|Poor weight gain]]: check height and weight- left-to-right can cause decrease in weight, but are usually symptomatic
	*Enlarged heart (ie [[ASD]]) can cause bulging of chest		**Color - cyanosis of hands, feet, perioral on exertion
	*Older kids - activity causing [[dyspnea]]/cyanosis- keeping up with peers, grunting, coughing, tired from stairs. [[Syncope (peds)\|syncope]]/presyncope, fatigue, [[palpitations]]/[[chest pain (peds)\|angina]] can occur with [[hypertrophic cardiomyopathy]]		**Feeding - fatigue or short feeding times for infants- perspiring, grunting, coughing, [[tachycardia]] while feeding. Severe [[CHF]] may show at rest deep breathing with [[dyspnea]] with distress
	*Yet older - Aortic valve with [[rheumatic fever]], [[myocarditis]] (history of [[URI]]), [[endocarditis]] (IV drug use)		**Enlarged heart (ie [[ASD]]) can cause bulging of chest
	*Pregnancy history - Maternal diabetes ([[ASD]], [[coarctation of the aorta]], cardiomyopathies), [[CMV]], [[Coxsackie]] B5, [[warfarin]], [[AEDs]] use, EtOH (ASD,[[VSD]]), prematurity ([[PDA]])		**Older kids - activity causing [[dyspnea]]/cyanosis- keeping up with peers, grunting, coughing, tired from stairs. [[Syncope (peds)\|syncope]]/presyncope, fatigue, [[palpitations]]/[[chest pain (peds)\|angina]] can occur with [[hypertrophic cardiomyopathy]]
	*Worry when - family history of [[[[HCM]]]]/sudden death and prominent apical thrust (indicates [[LVH]])		**Yet older - Aortic valve with [[rheumatic fever]], [[myocarditis]] (history of [[URI]]), [[endocarditis]] (IV drug use)
			**Pregnancy history - Maternal diabetes ([[ASD]], [[coarctation of the aorta]], cardiomyopathies), [[CMV]], [[Coxsackie]] B5, [[warfarin]], [[AEDs]] use, EtOH (ASD,[[VSD]]), prematurity ([[PDA]])
			**Worry when - family history of [[[[HCM]]]]/sudden death and prominent apical thrust (indicates [[LVH]])

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis: /* Clinical Features */

2019-08-18T16:47:18Z

Clinical Features

← Older revision		Revision as of 16:47, 18 August 2019
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	*Older kids - activity causing [[dyspnea]]/cyanosis- keeping up with peers, grunting, coughing, tired from stairs. [[Syncope (peds)\|syncope]]/presyncope, fatigue, [[palpitations]]/[[chest pain (peds)\|angina]] can occur with [[hypertrophic cardiomyopathy]]		*Older kids - activity causing [[dyspnea]]/cyanosis- keeping up with peers, grunting, coughing, tired from stairs. [[Syncope (peds)\|syncope]]/presyncope, fatigue, [[palpitations]]/[[chest pain (peds)\|angina]] can occur with [[hypertrophic cardiomyopathy]]
	*Yet older - Aortic valve with [[rheumatic fever]], [[myocarditis]] (history of [[URI]]), [[endocarditis]] (IV drug use)		*Yet older - Aortic valve with [[rheumatic fever]], [[myocarditis]] (history of [[URI]]), [[endocarditis]] (IV drug use)
	*Pregnancy history - Maternal diabetes ([[ASD]], [[coarctation of aorta]], cardiomyopathies), [[CMV]], [[Coxsackie]] B5, [[warfarin]], [[AEDs]] use, EtOH (ASD,[[VSD]]), prematurity ([[PDA]])		*Pregnancy history - Maternal diabetes ([[ASD]], [[coarctation of the aorta]], cardiomyopathies), [[CMV]], [[Coxsackie]] B5, [[warfarin]], [[AEDs]] use, EtOH (ASD,[[VSD]]), prematurity ([[PDA]])
	*Worry when - family history of [[[[HCM]]]]/sudden death and prominent apical thrust (indicates [[LVH]])		*Worry when - family history of [[[[HCM]]]]/sudden death and prominent apical thrust (indicates [[LVH]])

ClaireLewis at 16:46, 18 August 2019

2019-08-18T16:46:47Z

← Older revision		Revision as of 16:46, 18 August 2019
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	*Check height and weight- left-to-right can cause decrease in weight, but are usually symptomatic		*Check height and weight- left-to-right can cause decrease in weight, but are usually symptomatic
	*Color - cyanosis of hands, feet, perioral on exertion		*Color - cyanosis of hands, feet, perioral on exertion
	*Feeding - fatigue or short feeding times for infants- perspiring, grunting, coughing, tachycardia while feeding. Severe CHF may show at rest deep breathing with dyspnea with distress		*Feeding - fatigue or short feeding times for infants- perspiring, grunting, coughing, tachycardia while feeding. Severe [[CHF]] may show at rest deep breathing with [[dyspnea]] with distress
	*Enlarged heart (ie ASD) can cause bulging of chest		*Enlarged heart (ie [[ASD]]) can cause bulging of chest
	*Older kids - activity causing dyspnea/cyanosis- keeping up with peers, grunting, coughing, tired from stairs. ~~Syncopal~~/~~presyncopal~~, fatigue, palpitations/angina can occur with [[hypertrophic cardiomyopathy]]		*Older kids - activity causing [[dyspnea]]/cyanosis- keeping up with peers, grunting, coughing, tired from stairs. [[Syncope (peds)\|syncope]]/presyncope, fatigue, [[palpitations]]/[[chest pain (peds)\|angina]] can occur with [[hypertrophic cardiomyopathy]]
	*Yet older - Aortic valve with rheumatic fever,myocarditis (history of [[URI]]), [[endocarditis]] (IV drug use)		*Yet older - Aortic valve with [[rheumatic fever]], [[myocarditis]] (history of [[URI]]), [[endocarditis]] (IV drug use)
	*Pregnancy history - Maternal diabetes (ASD, coarctation of aorta, cardiomyopathies), CMV, Coxsackie B5, warfarin, ~~AED~~ use, EtOH (ASD,VSD), prematurity (PDA)		*Pregnancy history - Maternal diabetes ([[ASD]], [[coarctation of aorta]], cardiomyopathies), [[CMV]], [[Coxsackie]] B5, [[warfarin]], [[AEDs]] use, EtOH (ASD,[[VSD]]), prematurity ([[PDA]])
	*Worry when - family history of [[[[HCM]]]]/sudden death and prominent apical thrust (indicates LVH)		*Worry when - family history of [[[[HCM]]]]/sudden death and prominent apical thrust (indicates [[LVH]])

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*Most innocent murmurs are		*Most innocent murmurs are
	**Not holo or diastolic		**'''Not''' holo or diastolic
	**Not >grade III		**'''Not''' >grade III
	**Hockey stick dist		**Hockey stick dist
	**Normal S1 & S2		**Normal S1 & S2

ClaireLewis: /* Background */

2019-08-18T16:41:58Z

Background

← Older revision		Revision as of 16:41, 18 August 2019
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	==Background==		==Background==
	*72% of all school-age children have innocent murmurs		*72% of all school-age children have innocent murmurs
	*Congenital heart disease 0.8% of live births		*[[Congenital heart disease]]- 0.8% of live births

	==Clinical Features==		==Clinical Features==

← Older revision		Revision as of 19:49, 15 April 2026
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	*Low pitch, musical		*Low pitch, musical
	*Decreased with inspiration, sitting, standing. Not a VSD- not regurgitant or with thrill		*Decreased with inspiration, sitting, standing. Not a VSD- not regurgitant or with thrill

	====Innocent Pulmonary Flow Murmur====		====Innocent Pulmonary Flow Murmur====
	*Systolic best at left upper sternal border, minor turbulence in RV outflow tract and main pulmonary artery		*Systolic best at left upper sternal border, minor turbulence in RV outflow tract and main pulmonary artery
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	*Not Pulm M of ASD, no fixed splitting, no diastolic tricuspid flow rumble, no increased RV impulse		*Not Pulm M of ASD, no fixed splitting, no diastolic tricuspid flow rumble, no increased RV impulse
	*Decreased on inspiration/sitting/standing		*Decreased on inspiration/sitting/standing

	====Innocent Pulmonary Branch Murmur of Infancy====		====Innocent Pulmonary Branch Murmur of Infancy====
	*Systolic ejection murmur from turbulence in pulmonary artery branches (one or both)		*Systolic ejection murmur from turbulence in pulmonary artery branches (one or both)
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	*Transmits well to back and axilla. common in premature; disappears early in infancy		*Transmits well to back and axilla. common in premature; disappears early in infancy
	*Not PS- no ejection click, no increase in RV impulse		*Not PS- no ejection click, no increase in RV impulse

	====Supraclavicular Bruit====		====Supraclavicular Bruit====
	*Systolic ejection murmur of medium pitch from physiologic turbulence of carotid/subclavian and heard at base of neck		*Systolic ejection murmur of medium pitch from physiologic turbulence of carotid/subclavian and heard at base of neck
	*Can be palpable. Disappears on hyperextension of shoulders		*Can be palpable. Disappears on hyperextension of shoulders
	*Not AS which is loudest at URSB with systolic thrill, sometimes with click		*Not AS which is loudest at URSB with systolic thrill, sometimes with click

	====Venous Hum====		====Venous Hum====
	*Continuous murmur from turbulent flow in SVC heard at L,R,or B infraclavicular position while sitting/standing		*Continuous murmur from turbulent flow in SVC heard at L,R,or B infraclavicular position while sitting/standing
	*Not PDA (bounding pulse, systolic>diastolic sound) or AV malformation		*Not PDA (bounding pulse, systolic>diastolic sound) or AV malformation
	*Disappears in recumbent position, rotation of head, by pressure at jugular		*Disappears in recumbent position, rotation of head, by pressure at jugular

	====Mammary Souffle====		====Mammary Souffle====
	*Blood flow in A and V to engorged breast		*Blood flow in A and V to engorged breast
	*Systolic or continuous, disappears with stethoscope pressure		*Systolic or continuous, disappears with stethoscope pressure

	====Cardiorespiratory murmur====		====Cardiorespiratory murmur====
	*High pitched cooing, anywhere, but especially apex		*High pitched cooing, anywhere, but especially apex