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Should functional cardiac murmurs be diagnosed by auscultation or by doppler echocardiography?

Background: For many years, cardiac auscultation has been the only available method for distinguishing between functional and organic murmurs; however, a more reliable differential diagnosis can now be achieved with Doppler echocardiography. The question remains as to whether a Doppler echocardiogram needs to be routinely recorded in the presence of a heart murmur or whether the auscultatory diagnosis of a functional murmur is sufficient.