Always get to the child before the phlebotomist. As distracting as it might be, start by ignoring the murmur . First, define the nature of the first and second heart sounds. The combination of this information with the nature of the second heart sound will define whether a systolic murmur is functional and benign, or pathological. If you hear a systolic murmur in an asymptomatic child, the odds are on your side.
All pansystolic murmurs are pathological.
They almost always are VSDs. In a child with a VSD, the louder the murmur, the smaller the shunt . The softer the murmur, the larger the shunt, and the sicker the child. Children develop bi-ventricular failure. Palpate the liver.