Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Infant or child with a murmur

Clinical Discipline(s)/Organ System(s)
Cardiology, Cardiovascular System, Paediatrics
Progress Test Topic(s)
Cardiovascular, Child health
A one day old Chinese baby girl is found to be not feeding well. On examination the baby has a systolic murmur and is cyanosed.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the fetal heart and fetal and postnatal circulation
   - Transition at birth from fetal to postnatal circulation
   - Factors contributing to the closure of the ductus arteriosus
   - Most common congenital heart diseases (CHD) and their pathogenesis
   - Normal ranges of respiratory rate, heart rate and blood pressure in newborns
   - Role of teratogens in congenital abnormalities
Clinical and Communication Skills 
   - Obtain a relevant history from the parents
   - Detailed cardiovascular examination (vital signs/pulse volumes/perfusion/heart sounds); differentiate innocent from pathological murmurs
   - Assess for associated abnormalities (dysmorphic features) and identification of common genetic syndromes associated with congenital heart disease
   - Determine pre- and post-ductal saturations with a pulse oximeter
   - Requirements for adequate oxygen delivery to meet metabolic needs
   - Interpret chest X-ray
   - Use of prostaglandin E1 in the management of CHD
   - Identify signs and symptoms of cardiac failure
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Prompt referral to Paediatric Cardiology service
   - Discuss clinical findings with parents and explain the need for further investigation
   - Difficult conversations with parents; life-limiting conditions such as ventricular hypoplasia
   - Best interests principle
   - Use of interpreter
Hauora Māori 
   - Appropriate engagement and consultation with whānau
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Understanding of inequities in access to health services and quality of medical care for Māori
   - Consideration of access to cultural/spiritual support for patient and whānau
Population Health 
   - Epidemiology of CHD: causes, risks, screening for in neonates
   - Risk of CHD in first degree relatives
   - Risk of CHD in babies of diabetic mothers
   - Maternal exposure to cardiovascular teratogen (anticonvulsants/rubella/alcohol)
   - Awareness of impact of socioeconomic deprivation on Māori and others (e.g. burden on families who have to travel to tertiary centre to receive treatment)
   - Knowledge of antenatal screening programmes
Conditions to be considered relating to this scenario
congenital heart disease, respiratory distress syndrome, innocent murmur
Less common but 'important not to miss'
persistent pulmonary hypertension, cyanotic congenital heart disease, sepsis
metabolic disorders