Heart murmurs in infants and children

Heart murmurs are a common finding during the physical examination of a child. Up to 80% of children will have a murmur at some point during their childhood. Murmurs are a reason for referral from primary to secondary care. Most murmurs, particularly beyond infancy, will be innocent murmurs which are not secondary to underlying pathology. The challenge in general practice is to identify those patients at higher risk of underlying heart disease needing further assessment and treatment by paediatric cardiology. This article aims to provide a practical approach to assessing a paediatric patient with a heart murmur in primary care and clinical scenarios comparing innocent versus pathological murmurs.