Christine Tracy, MD, Christine A. Walsh, MD, 2016. "Heart Murmurs (Chapter 159)", American Academy of Pediatrics Textbook of Pediatric Care, Thomas K. McInerny, MD, FAAP, Henry M. Adam, MD, FAAP, Deborah E. Campbell, MD, FAAP, Thomas G. DeWitt, MD, FAAP, Jane Meschan Foy, MD, FAAP, Deepak M. Kamat, MD, PhD, FAAP, Rebecca Baum, MD, FAAP, Kelly J. Kelleher, MD, MPH, FAAP
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A heart murmur is a common finding during the physical examination of children. However, few children with heart murmurs have structural cardiac disease. The challenge for the pediatrician lies in distinguishing innocent murmurs from those that indicate a cardiac abnormality.
The pediatrician needs to understand the events of the cardiac cycle and its associated heart sounds when determining the significance of a heart murmur. Heart sounds are directly related to the hemodynamic events of systole and diastole (Figure 159-1).
The first heart sound (S1) is related to the closure of the mitral and tricuspid valves at...