RHC for Health Professionals
Any infant less than 3 months of age who presents with a murmur associated with breathlessness or sweating when feeding, cyanosis, tachypnoea, hepatomegaly, or failure to thrive would prompt an Urgent referral to Paediatric Cardiology.
Child with a Heart Murmur: Advice for Referrers
Warning
Most murmurs in healthy asymptomatic children are innocent. The key characteristics of an innocent murmur are they are:
- Always – intensity less than 4/6, no radiation, normal peripheral examination, not diastolic
- Usually – intensity less than 3/6, short in duration, single, change with position, musical or vibratory
Most children will have an innocent murmur at some point during childhood and some persist until adolescence.
Detailed antenatal scanning can pick up major heart defects but a normal antenatal ultrasound does not rule out all cardiac defects.
The majority of pathological heart murmurs are picked up in early infancy.
- Symptoms – concerns (if any) about weight gain in infants or growth in older children, any colour changes, any central cyanosis (perioral cyanosis and acrocyanosis in infants is normal), shortness of breath, chest pain or syncope (on exertion is particularly important to ask about)
- Has the murmur been heard before?
- Any family history of congenital cardiac disease?
- Central cyanosis (if possible measure and document an oxygen saturation)
- Growth parameters – weight and height/length (if possible)
- Blood pressure (if possible)
- Pulses – femoral pulses should be documented
- Heave - present or absent
- Thrill - present or absent
- Description of the murmur
Arrange to review the infant or child again to reassess the murmur if felt to be innocent in nature.
- If thought to be innocent murmur: Innocent murmur parent fact sheet - Incidental Murmurs
- West of Scotland Neonatal Guideline - Heart murmurs in the neonate: an approach to the neonate with a heart murmur