Cardiac murmurs in childhood.

Innocent heart murmurs can be identified and distinguished from organic murmurs using only clinical skills. Pulmonary flow murmurs may be differentiated from those of atrial septal defect or pulmonary stenosis by the behavior of the second heart sound, parasternal vibratory murmurs from ventricular septal defect, aortic stenosis and mitral regurgitation by their length and radiation, venous hums from patent ductus arteriosus by maneuvers designed to obliterate the hum, and supraclavicular arterial murmurs from carotid artery bruit, aortic stenosis and coarctation by similar maneuvers and blood pressure recordings. The article outlines the points of differentiation in order to arrive at a firm diagnosis and obviate concern and unnecessary referrals.