Timely and appropriate diagnosis and treatment of valvular heart disease is an important skill for family physicians. Excessive consultation and diagnostic testing of patients who present with murmurs creates unnecessary anxiety and cost. Yet the failure to make a timely diagnosis of valvular heart disease, or to refer when appropriate, can lead to irreversible cardiac damage, decreased functional status, and even death. In making the diagnosis of valvular heart disease, it is important to know the clinical maneuvers that can help refine the bedside diagnosis of murmurs. It is useful to know when third and fourth heart sounds (S3 and S4) are abnormal, and how to distinguish innocent and physiologic murmurs from murmurs caused by valvular heart disease.