In evaluating a 1-month-old male with a holosystolic murmur, what is the next step if the physical examination is normal?

In the case of a 1-month-old male exhibiting a holosystolic murmur with a normal physical examination, the most appropriate next step is to perform an echocardiogram to assess for a ventricular septal defect (VSD). Holosystolic murmurs are often associated with VSD, particularly in infants, due to the shunting of blood from the left ventricle to the right ventricle through the defect.

An echocardiogram is a non-invasive imaging study that provides valuable information about the heart's structure and function, allowing for a clear diagnosis of any congenital heart defects. Since VSDs can lead to significant complications such as heart failure or pulmonary hypertension if left undiagnosed, it is crucial to investigate this finding promptly.

Referral to a specialist or immediate surgery may not be the first steps when the physical examination is otherwise normal unless there are additional concerning findings. Observation without further testing may delay the diagnosis of a potentially significant condition like a VSD, which could impact the child's health if not addressed. Thus, the echocardiogram is essential for a thorough evaluation in this clinical scenario.