Difficulties in evaluating systolic murmurs in children; with special reference to the functional systolic murmur.

As a guide in distinguishing between organic and functional systolic murmurs, five characteristics of a murmur should always be noted, namely, (a) the location of maximal intensity of the murmur; (b) the intensity of the murmur itself; (c) the character of the murmur, that is, whether it is blowing, rumbling, rough or harsh; (d) the transmission of the murmur; and (e) the duration of the murmur and its time within the cardiac cycle. Functional systolic murmurs may be found at any of the "valve areas," are usually faint to moderately loud, are usually soft and blowing in quality, are usually only slightly transmitted, and are usually not heard immediately following the first heart sound. In doubtful cases, those in which history and physical examination alone are not sufficient to make a diagnosis of functional systolic murmur, further studies should be undertaken to determine the presence or absence of organic heart disease. Until a diagnosis of organic heart disease can be made with reasonable certainty, there should be no restriction of activity imposed, because of the likelihood of the development of cardiac neurosis in the patient.