Approach to a murmur (pediatrics) Quiz: Ace Your Exams

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A 6-year-old girl presents to the pediatric office for a well-child visit. She is accompanied by her parent, and they have no concerns at this time. The patient is growing and developing appropriately for her age. Height is 58th percentile, weight is 45th percentile. Temperature is 37°C (98.6°F), heart rate is 106/min, blood pressure is 94/56 mmHg, respirations are 22/min, and oxygen saturation is 98% on room air. On physical examination, the patient is well-appearing and in no acute distress. Cardiovascular examination reveals a regular heart rate, femoral pulses are 2+, capillary refill is < 2 seconds, and a new murmur is heard. Which of the following characteristics of the murmur, if heard, would be reassuring that the murmur is benign?

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Intensity increases when the patient is supine

Intensity increases with Valsalva

Holosystolic

Machinery-like

Grade IV/VI murmur