The cardiac examination in children.

The physical examination requires careful palpation of pulses and measurement of blood pressure, evaluation of heart sounds (including detection of the third heart sound) and appreciation of clicks and murmurs. Combined with the chest x-ray and electrocardiographic findings, these steps usually lead to the most common diagnoses: innocent murmur; left-to-right shunt (atrial or ventricular septal defect, patent ductus arteriosus); obstructive lesion (pulmonic or aortic stenosis, coarctation of the aorta), and mitral valve prolapse.