Heart Murmur

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

Red flag signs requiring Urgent Referral or Admission:

  • 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


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

Please send an ECG if possible at time of referral



Inherited Cardiac conditions screening

In the absence of clinical signs, please refer as routine to Paediatrician with Expertise in Cardiology clinics with detailed family history (including index case).

Please also include if any clinical genetics input has been sought in the past.


Refer if:

1) If first degree relative has left ventricular outflow tract obstruction lesion (Hypoplastic left heart syndrome, bicuspid aortic valve, aortic stenosis)


2) If first degree relative (especially if parents) has syndrome like Alagille, RASMAPK, Elastin.


3) If first degree relative has any of the below:

  • Channelopathies- Long QTsyndrome, Brugada syndrome, CPVT
  • Cardiomyopathies- Hypertrophic  Cardiomyopathy, Dilated Cardiomyopathy,  ARVC
  • Neuromuscular disease
  • Muscular dystrophies
  • Myotonic dystrophy
  • Mitochondrial myopathies
  • Family history of sudden death


For those children with a second degree family history, the first degree family members should be investigated first and then referral made if advised by adult cardiology or genetics.

Children with William’s Syndrome, Noonan’s syndrome and Turner’s Syndrome must also be under paediatric cardiology follow up.



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

These patients should 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 S Burns GP


Dr Sam Padmanabhan, Constulant Paediatrician with Expertise in Cardiology RCHT

Dr Katy Huxstep, Consultant Paediatrician with Expertise in Cardiology RCHT.

Date:June 2021

Review Date:June 2022

Version 1.2