Evaluation of the pediatric patient with a cardiac murmur.

In conclusion, the evaluation of cardiac murmurs represents one of the most skilled and demanding aspects of the pediatric physical assessment. It does provide a significant service to patients and a level of satisfaction for competent practitioners, and referral is not always warranted. The decision for referral is based on the presumed diagnosis, confidence of the examiner, and level of parental anxiety. Most often, referral to a cardiologist for directed investigation rather than direct echocardiographic assessment serves patients best.