Cardiac murmur in paediatric patients

​​​Emergency

If any of the following are suspected, please seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary).

Newly noted cardiac murmur with any of the following features:

  • Aged < 3 months with any of the following features:​
    • Central cyanosis
    • Poor feeding
    • Post ductal (foot) oxygen saturation < 95%
    • Weak or absent femoral pulses in a newborn < 4 weeks of age
  • Haemodynamic instability
  • Persistent or progressive shortness of breath (NYHA Class III – IV)
  • Signs of heart failure (e.g. poor oral intake, respiratory distress, weight loss)

  • Signs or symptoms of rheumatic fever or infective endocarditis

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days
  • Aged 3-12 months with a murmur and any of the following features:
    • Down syndrome or other syndromes
    • Genetic conditions known to be associated with congenital heart disease
    • Failure to thrive
    • Weak or absent femoral pulses
    • Increased work of breathing
  • Asymptomatic murmur and aged 0-3 months
  • Asymptomatic murmur at any age in association with acute rheumatic fever

Category 2
Recommended to be seen within 90 calendar days

  • Asymptomatic murmur and aged 3-12 months
  • Asymptomatic murmur, aged > 5 years and any of the following features:
    • Identifies as Aboriginal and/or Torres Strait Islander
    • Identifies from a refugee background
  • Cardiac murmur at any age with a history of rheumatic fever

Category 3
Recommended to be seen within 365 calendar days

  • Asymptomatic murmur and aged > 12 months

Information to include within a referral

Required

  • Reason for referral

  • Details of the presenting condition, including symptoms and their duration, or impact on activities of daily living and school attendance

  • Provisional diagnosis

  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:

    • Physical findings including colour assessment, oxygen saturation, clubbing, weak or absent femoral pulses
    • Presence or absence of the following features:
        • Cyanotic episodes or blue spells
        • History of exercise intolerance, syncope or palpitations

If available

  • Any relevant laboratory results including electrocardiogram (ECG), chest X-ray or other medical imaging reports, urinalysis result

  • Family history of first-degree relatives with congenital cardiac disease

  • Growth charts, height, weight and/or head circumference with prior measurements

  • Known other congenital abnormalities

  • Other physical examination findings including of central nervous system, birth marks or dysmorphology

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.


 

Current as at: Tuesday 22 September 2026
Contact page owner: System Purchasing