Physiologic murmurs are relatively common in pediatric patients. The patient may be referred to a cardiologist for evaluation. Auscultation while standing can identify a physiologic murmur without expensive testing. The authors are from Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, University Francois Rabelais, and University Hospital Centre of Poitiers in France.
Patient selection: 2 to 18 years with murmur
Features of physiologic murmur:
(1) systolic
(2) low intensity
(3) decrease in intensity or disappearance on standing
(4) location over low to middle left sternal border
(5) absence of radiation
(6) absence of associated symptoms
Criteria for test:
(1) isolated heart murmur while supine
(2) disappearance of murmur while standing
(3) otherwise healthy and asymptomatic
(4) negative family history
False positive: atrial septal defect (ASD)
Performance:
• The specificity was 93%, sensitivity 60% and positive predictive value 98%.
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