617 Outcome of Murmurs Beyond Infancy

Abstract

Aim: Aim is to find out outcome of children above 1 referred with murmurs. Methods: This is a retrospective audit of patients above 1 referred between April 2007 and October 2009 to consultant paediatrician with expertise in cardiology at a paediatric cardiac clinic in a district general hospital. Results: 190 of 700+ seen in cardiac clinic were children above 1 year of age referred for murmur± associated problems. 55 were from General Practitioners (29%) and 135 from Paediatric colleagues (71%). Murmur resolved in 16% (31/190) proportionally from each group. Of remaining 159 children with persistent murmur, clinical examination and echocardiography confirmed innocent murmur in 140 (88%) and they were discharged. 19 children (12% of each group) were diagnosed to have congenital heart disease. Cardiac diagnoses were Ventricular Septal Defect (8), AtrioVentricular Septal Defect (1), Patent Ductus Arteriosus (2), Atrial Septal Defect (3), Aortic Stenosis (3) and Branch Pulmonary Stenosis(2). 6 of these (31%) with significant lesions were referred to tertiary cardiac centre for further assessment/intervention. Conclusion: Childhood murmurs are sometimes transient and vast majority of persistent murmurs are innocent. Asymptomatic murmurs after infancy could be reviewed by paediatricians and persistent or symptomatic ones referred to paediatric cardiac clinic. Facility to perform an echocardiography at district general hospital will help in confirming innocent murmurs and more importantly reassuring anxious parents. It also has a role in detecting few, yet significant, congenital heart conditions that could then be referred on to tertiary centre.