Paediatric heart disease in general practice

Abstract

Paediatrics is an important aspect of general practice, and paediatric cardiology frequently impinges on the general practitioner. The most common dilemmas encountered circle around murmurs. While many normal children have heart murmurs, very very few actually have any cardiovascular pathology. The usual medical platitude does actually apply, in that children who actually have cardiac disease can be identified by a careful history and examination. The practice of referring all children with murmurs for paediatric cardiology assessment or simply 'for an echo' is to be discouraged. Only patients with organic murmurs and those in whom uncertainty persists after examination should be referred. Functional murmurs should not be referred except for pulmonary ejection murmurs (see table) which may be difficult to distinguish from an atrial septal defect.