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A murmur is a finding—not a diagnosis.

Some systolic murmurs are physiological. Others reveal important valvular, congenital or myocardial disease. The clinical task is to describe the sound accurately, connect it to physiology, identify complications and decide who needs investigation or specialist care.

In Episode 5 of The Clinical Next Step, we work through a practical approach to heart murmurs and abnormal heart sounds.

You will learn how to:

• Describe a murmur by timing, shape, location, radiation, intensity and response to manoeuvres • Interpret abnormal S1, S2, S3 and S4 findings • Use inspiration, standing, Valsalva, squatting and handgrip to refine the differential • Distinguish reassuring innocent patterns from pathological findings • Recognize patterns associated with aortic stenosis, mitral regurgitation, aortic regurgitation, mitral stenosis, tricuspid regurgitation and obstructive hypertrophic cardiomyopathy • Identify concerning pediatric findings and abnormal S2 splitting • Recognize complications such as heart failure, atrial fibrillation and infective endocarditis • Choose appropriate investigations, including ECG and echocardiography • Decide when urgent assessment or specialist referral is required • Apply endocarditis prophylaxis only when indicated

The central reasoning sequence:

Describe the sound. Determine whether the patient is stable. Identify the likely mechanism. Look for severity and complications. Choose the investigation that resolves the next decision.

Recognize the pattern. Find the danger. Choose the next step.

For medical education and exam preparation only. This episode does not replace patient-specific assessment, current clinical guidelines, local protocols or professional medical judgment. The Clinical Next Step is an independent educational project and is not affiliated with or endorsed by the Medical Council of Canada.