Role of the Patient History
In the evaluation of heart murmurs the history plays a major role. The history
must be age-specific, must include a detailed family history of heart disease,
and must focus on symptoms known to occur as a result of altered cardiac function.
Such symptoms in infants include rapid breathing, poor feeding, poor weight
gain, a weak cry and profuse sweating.In older children and adolescents, symptoms
highly specific for significant heart disease include: exercise intolerance,
exertional dyspnea, exertional cough, exercise-induced syncope, angina, palpitations.
It is important to realize also that children born with hemodynamically non-significant
cardiac defects such as small ventricular septal defects or mild pulmonic stenosis
are asymptomatic. The significance of a heart murmur therefore must be interpreted
in the context of the specific clinical setting.Accordingly, a soft (grade 2/6)
systolic murmur in a child with symptoms of heart failure is a very significant
finding and a strong indicator of a life-threatening form of heart disease,
whereas a similar murmur in a healthy child with fever and anemia is a finding
of little significance.
Proceed to the Physical Exam