Dawaa Reference

chronic

Heart or arterial murmur

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KS52 - condition scope only, no dose · Innocent Murmur - StatPearls - NCBI Bookshelf (NBK507849) - https://www.ncbi.nlm.nih.gov/books/NBK507849/ · No dose - referral pathway, no medicine given in primary care

Verified against3 documents
  • No dose - referral pathway, no medicine given in primary care
  • Innocent Murmur - disease-level clinical article (heart-or-arterial-murmur-full.txt)
  • Innocent Murmur - disease-level clinical article (heart-or-arterial-murmur-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (2)

  • Feeding difficulties such as sweating during feeds, poor growth, colour change with feeding or activity, and fast or laboured breathing matter in newborns with a murmur [breathlessness · failure to thrive · heart murmur · sweating]
  • A new murmur with reduced activity, worsening exercise tolerance, breathlessness, chest pain, or fainting on exertion raises major concern for heart disease [breathlessness · chest pain · heart murmur · syncope]

Signs — what you find (12)

  • A grade 2 or louder murmur in the first 24 hours of life is more likely to reflect true heart disease, while softer murmurs in the first few days often reflect normal circulatory changes [heart murmur]
  • A pre- and post-ductal oxygen saturation gap of under 3%, with normal overall readings, rules out many congenital heart lesions
  • A higher blood pressure reading in the arm than the leg raises concern for aortic coarctation
  • In a normal child the femoral pulse is felt slightly before the brachial pulse
  • A displaced point of maximal impulse or an overactive precordium on palpation suggests an enlarged heart
  • A murmur present throughout systole is usually pathologic, as with a VSD, and any purely diastolic murmur is treated as pathologic until proven otherwise [heart murmur]
  • A murmur graded above 3 out of 6 should be treated as pathologic until proven otherwise [heart murmur]
  • A high-pitched murmur is usually pathologic, while most innocent murmurs are low, soft, and vibratory [heart murmur]
  • A murmur that stays the same intensity with positional changes, particularly a valvular one, is more likely pathologic, while innocent murmurs often change with position [heart murmur]
  • A soft, musical, low-pitched murmur at the lower left sternal border and apex, loudest lying flat, is typical of a Still murmur [heart murmur]
  • A venous hum disappears completely when the patient lies flat or turns the neck to the right
  • A fixed split of the second heart sound is the clearest sign of an atrial septal defect, present even without a murmur

Tests (3)

  • A pathologic-sounding murmur should be referred to a cardiologist
  • Chest x-ray and ECG add little diagnostic value once a specialist has examined the patient
  • If concern remains after a cardiologist's exam, an echocardiogram for anatomic visualisation is usually the next step

SourceStatPearls "Innocent Murmur" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)

1st line
Adult dose and duration

This is an examination finding, not a diagnosis in itself; what is prescribed, if anything, depends entirely on the underlying cause found on further workup. - Refer

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

This is an examination finding, not a diagnosis in itself; what is prescribed, if anything, depends entirely on the underlying cause found on further workup.

Cautions
  • Signs of heart failure, syncope, chest pain, fever with a new murmur, diastolic murmurs (usually pathological).
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - New murmur with decreased activity level, worsening exercise tolerance, shortness of breath, chest pain, or exertional syncope raises major concern for cardiac pathology.
  • RED FLAG - Purely diastolic murmurs are by definition always pathologic until proven otherwise.
  • RED FLAG - Suspected pathologic murmurs warrant referral to a cardiologist.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.