A 12-year-old male has a murmur that increases when sitting. What is the next appropriate step?

In a situation where a 12-year-old male has a murmur that intensifies with sitting, the next appropriate step is to order an echocardiogram. This non-invasive imaging technique allows for a comprehensive evaluation of the heart's structure and function, which is essential for determining the significance of the murmur. Since the murmur is changing with body position, it raises the possibility of hemodynamic changes or structural abnormalities that may warrant further investigation.

Echocardiography can help differentiate between benign murmurs, often common in children due to physiologic blood flow changes, and murmurs that may be indicative of underlying cardiac pathology, such as valvular heart disease or septal defects.

While observation and re-evaluation in a year may seem reasonable, it does not provide timely information about the potential cardiac issues that could be present and does not address the immediate concern raised by the murmur. Similarly, a chest X-ray, while useful for visualizing the heart and lung fields, does not provide the detailed information necessary to assess heart structure and function as effectively as an echocardiogram. Immediate referral to a cardiologist might be considered excessive without first obtaining imaging to understand the situation better, making an echocardiogram the