Management of asymptomatic heart murmurs

Asymptomatic cardiac murmurs are a common finding in paediatric patients with some estimates suggesting that 90% of children have a murmur detected at some stage. Most are benign ‘innocent’ noises or reflect minor structural heart disease of no haemodynamic significance. The degree of parental anxiety invoked by the detection of a murmur in their child is considerable and although in virtually all cases their concerns of significant underlying cardiac disease are unjustified, providing adequate reassurance is a challenge for the health professionals involved. The aim of this article is to guide practitioners in determining which babies or children need urgent referral for a specialist opinion and to provide management suggestions for when a murmur is noted coincidentally during a routine examination.