Screening for congenital heart disease

Neonates

  • Hospital discharge increasingly early – more detection by GPs
  • Babies with murmurs should ie referred for early paediatric cardiological assessment
  • Little point in review and delaying referral
    • risky
    • delays definitive diagnosis
    • pulmonary vascular disease
    • parental anxiety

Children

Benign murmurs are common; more marked when the child is pyrexial with an intercurrent illness. In this instance review in a couple of weeks is justified.

  • Benign murmur
    • high pitched or musical
    • localised to lower left sternal border
  • vary with position and respiration
  • Venous hum
    • high pitched continuous murmur below the clavicle or in the neck
    • disappears on lying flat

Explain what a murmur is when you refer (‘an extra sound when you listen to the heart’). Many people interpret ‘murmur’ as a definite heart problem or as a physical entity inside the head.

Blood pressure

A controversial part of childhood screening,  it may be the only sign of serious underlying renal disease

HOCM screening

  • Much recent publicity
  • it is very rare
  • no proven treatment for reducing the risk of sudden death
  • avoiding exercise does not remove the risk of sudden death
  • the negative aspects of detection should be explained (as in HIV test counselling)
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