[A heart murmur - a frequent incidental finding].

A heart murmur - a frequent incidental finding Abstract. Heart murmurs are very common and are present in up to 80 % of school children and 52 % of adults. They originate from the transition from laminar to turbulent blood flow in patients with a structural cardiomyopathy (so-called "organic" murmurs) or in patients with normal hearts (so-called "innocent" murmurs). A detailed history and physical examination help to discriminate innocent from organic murmurs. With the wide availability of transthoracic echocardiography (TTE) cardiac auscultation has lost a lot of its importance, although it remains an important skill for the initial evaluation and triage. An innocent murmur is a minor (1 / 6 - 2 / 6), crescendo-decrescendo, mostly position-dependent, mid-systolic murmur without radiation, which needs no further workup in asymptomatic patients with normal physical capacity. A TTE should be ordered if signs for a cardiac disease are present based on history, physical examination or other tests. Diastolic and continuous murmurs are mostly pathologic and warrant further workup.