Heart murmurs

Evaluation of heart murmurs requires an understanding of basic cardiac physiology relating to the events of the cardiac cycle. Innocent and pathologic cardiac murmurs often can be differentiated with only a comprehensive history and skilled auscultation and without ancillary studies. Although easily acquired, auscultation is a skill that requires continued practice. Innocent murmurs are common, and parents need to be assured of their benign nature and the reasons they occur. There is no substitute for development of a skill other than through practice. Just as in sports, so it is with auscultation. We are fortunate that today's practice of auscultation is not confined to listening to patients. Digital recordings of heart sounds have a much improved fidelity, [Click here for a Data Supplement comprising 16 heart murmurs] and listening to these recordings does improve auscultatory skill. In a recent study, Barrett and colleagues found that having medical students listen to recordings multiple times improved their skills such that they could recognize 80% of the heart sounds compared with their pretest ability of recognizing only 30%. (2) Therefore, with only a few minutes of practice each day, thinking about what to listen to and for, the clinicians can become skilled in the art of auscultation.