text_1: I saw an almost 3-year-old girl this morning.  She had a ventricular-septal-defect murmur at birth, never had an echocardiogram, just went by the sound of it.  She had a little murmur now in the pulmonic area, intermittent, I hear it with inspiration.  The question was, well what is it exactly and where do I look it up exactly and I decided, well, I'm not going to find that anywhere, so I'm referring him on.
text_2: What is causing this systolic murmur?