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Heart Murmurs

The single commonest referral problem to a paediatric cardiologist, heart murmurs are very common particularly in the toddler age of 1-4 years.  Whilst nearly 90% of congenital heart disease has presented by the first birthday, separating the common ‘innocent or flow murmurs’ from the less common ‘significant murmur’ presents a challenge to the medical practitioner.

In general terms the louder the noise and the closer in time to birth that it is first detected the more significant the murmur will be in terms of identifying “occult” CHD. In addition the following are RED FLAGS for referral:

  • Persistent and unexplained tachypnoea >14 days in a neonate 
  • Slow or prolonged feeding pattern or excessive sweating during feeds 
  • Failure to thrive in infancy 
  • Weak or absent femoral pulses
  • A palpable thrill

The chest x ray and electrocardiogram have a limited role in screening for heart disease in children with murmurs We don’t require these tests prior to referral. Following our clinical assessment an ECHOCARDIOGRAM will usually be completed if there are significant findings

Our policy is to decline requests for an ‘Echocardiogram only’ in children under the age of 5 years. We prefer to assess young children ourselves first as sedation is often required to get an adequate examination in this age group.

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