Evaluation of heart murmurs in paediatrics: a lost skill in the era of echocardiography?

Heart murmur is the commonest reason for referral to paediatric cardiology services. Although congenital heart disease (CHD) is common, affecting between 6 and 10 in 1000 live births most heart murmurs are innocent. This is particularly likely in the absence of any cardiac symptoms. When a murmur is heard, it is important to be able to determine which children need urgent assessment by specialist services and which ones can safely wait for a more routine evaluation. Appropriate information and sensible reassurance should be offered to parents. A good clinical assessment, as outlined in this article, will enable Paediatricians with expertise in Cardiology (PECs) and Paediatric Cardiologists (PCs) to safely triage patients and ensure services do not become overwhelmed with demand. This article aims to provide a structured approach to all health professionals who encounter paediatric patients with heart murmurs.