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July 1, 1933


Author Affiliations

From the Pediatric Department and the Cardiographic Laboratory of the Mount Sinai Hospital.

JAMA. 1933;101(1):17-20. doi:10.1001/jama.1933.02740260019005

There are few differential diagnoses more difficult, and at the same time more important, than the differentiation between organic and functional murmurs. This question assumes a particular significance in childhood, when functional murmurs are common and when early rheumatic infection may give rise to faint systolic murmurs. In a given case the diagnosis of such soft blowing murmurs calls for most careful judgment, for the evaluation of the type of murmur is of extreme importance as regards the subsequent treatment of the child.

Various diagnostic criteria have been proposed to aid in distinguishing between organic and functional murmurs. Briefly stated, they are as follows:

Time in Cycle.  —A functional murmur is almost invariably systolic, rarely diastolic, in time.

Quality.  —Generally speaking, the functional murmur is very short and blowing. It rarely has the rough, rasping, or even musical qualities that are characteristic of organic murmurs.

Duration.  —As a rule, the