1. Innocent murmur
2. Differences in child's heart vs. adult

Innocent murmur

• Normal split 2nd heart soundsplit widens on inspiration.
• Systolicsoftand short.
• Audible over L sternal border or pulmonary areaover a relatively small area.
• Child is asymptomatic.
• No associated cardiac abnormalities: no thrills palpableperipheral pulses are present.

Differences in child's heart vs. adult

• Sinus (respiratory) arrhythmia is much more prominent.
• In childheart occupies relatively more space in the thorax.
• <7 years: apex beat is in 4th intercostal space to the L of midclavicular line.

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