# Heart or arterial murmur - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - No drug therapy in primary care (Recognition & Referral) ## Complete treatment card ```text HEART OR ARTERIAL MURMUR 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 Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Innocent Murmur" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)