Heart murmurs are common, although most are innocent in nature and <1% are associated with congenital heart disease
Routine cardiac auscultation for children <2yrs presenting for preoperative assessment for the first time (where there is no record of a previous examination) is recommended
History
Features suggesting a pathological murmur
Recurrent chest infections
Feeding difficulties
Failure to thrive
Family history of sudden death
Reports of cyanosis, sweating or tachypnoea
Examination
Innocent murmurs
Pathological murmurs
Soft/blowing/musical/vibratory
Variable/loud/harsh
Early systolic Continuous ('venous hum')
Pan- or late-systolic Diastolic
Non-radiant
Radiates
No associated precordial thrill
Associated thrills
Often vary with posture
Rarely vary with posture
Innocent (Still) murmurs are heard in ~10% or normal children
Palpate all four limb pulses; aberrance may indicate coarctation of the aorta
Abdominal distension with hepatic enlargement, splenic enlargement or ascites indicates congestive cardiac failure
One should investigate:
Any murmur in <1yr old
Pathological murmurs e.g. loud, pansystolic/late systolic/diastolic
Those with associated concerning symptoms/signs
Those with an abnormal CXR or ECG
This includes:
A paediatric opinion; any child <1yr with a murmur should be referred to a paediatric cardiologist
Delaying surgery (unless emergent)
An ECG:
To exclude HOCM or critical aortic stenosis e.g if LVH or LAD
To exclude ASD e.g. increased P-wave in lead II, either left (primum) or right (secundum) axis deviation