Some murmurs are innocuous and "innocent". It is important to recognize an innocent murmur so that the patient is not mislabeled and does not have unnecessary testing.
Features of an innocent cardiac murmur:
(1) The murmur is detected along the left sternal border.
(2) The murmur has an intensity of Grade 1 or 2 (out of 6).
(3) The second heart sound is normal.
(4) There are no other murmurs or abnormal sounds.
(5) There is no evidence of ventricular hypertrophy or dilatation.
(6) The murmur does not increase in intensity when the patient stands up from a squatting position or when the patient does the Valsalva maneuver.
(7) The patient often has a high-output cardiac state (anemia, pregnancy, etc).
If in doubt echocardiography can be done to document normal valves.
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