Heart Murmur

All persistent heart murmurs in children need referral to paediatrician with expertise in cardiology clinics

Look for red flag signs

  • Red flag signs requiring urgent referral to Paediatrician with Expertise in Cardiology clinics are Children with heart murmur who are/have
  • Age under 1 month
  • Failure to thrive
  • Breathlessness  or sweating with feeding
  • Cyanotic episodes
  • Low oxygen saturations < 95% 
  • Signs of heart failure
    • Hepatomegaly
    • Gallop rhythm
    • Tachypnoea / tachycardia
    • Prominent precordial pulsations
  • Abnormal femoral pulses (sign of coarctation)
  • Exercise induced symptoms (Palpitations /chest discomfort/  syncope  during exercise)
  • High blood pressure

      Please send an ECG if possible at time of referral

  • If no above red flag signs refer as routine to Paediatrician with Expertise in Cardiology clinics





Inherited Cardiac conditions screening

  • Bicuspid aortic valve
  • Channelopathies- Long QTsyndrome, Brugada syndrome, CPVT
  • Cardiomyopathies- Hypertrophic  Cardiomyopathy, Dilated Cardiomyopathy,  ARVC
  • Neuromuscular disease
  • Muscular dystrophies
  • Myotonic dystrophy
  • Mitochondrial myopathies
  • Marfan syndrome
  • Ehler Danlos syndrome
  • Please refer as routine to Paediatrician with Expertise in Cardiology clinics with detailed family history (including index case) and any associated symptoms

Chest pain, Syncope and Palpitations

  • Please ascertain if symptoms are present during peak exercise
  • If symptoms are not present during exercise refer to General Paediatric clinics
  • Symptoms present during peak exercise need urgent referral to Paediatric with Expertise in cardiology clinics.  An ECG should be done at time of referral to triage the urgency

Known Congenital heart disease relocating to the area – to be referred to Paediatrician with Expertise cardiology clinics only for cardiac issues. They should have a separate referral to general paediatrics if they have other problems alongside congenital heart disease




Dr Sam Padmanabhan, 2018