DCH Revision Guide · Chapter 4

Cardiology: murmurs, congenital heart disease and the cyanosed infant

Written by Dr Victoria Hammond, MBBS, BSc (Hons) · NHS GP PartnerReviewed 5 October 20266 min readChapter 4 of 12

Why it matters in the exam

Most murmurs in childhood are innocent. A few are the first sign of a heart that will fail. The DCH tests whether you can hold both facts at once: reassure confidently when reassurance is right, and refer urgently when it is not.

Congenital heart disease also generates two of paediatrics' true emergencies — the collapsed neonate with a duct-dependent lesion, and the cyanosed infant. Both are high-yield because the correct action is time-critical and the wrong action is fatal.

What this chapter covers

  • 4.1Innocent murmurs: the seven S'sAn innocent murmur is Soft, Systolic, aSymptomatic, left Sternal edge, Short, with normal heart Sounds, and it…Preview below
  • 4.2Features that make a murmur pathologicalA murmur in a neonate should be assessed before discharge; a murmur with any of the above needs paediatric car…Members
  • 4.3Heart failure in infantsInfants do not complain of breathlessness; they show it at the breast or bottle. The classic triad is poor fee…Members
  • 4.4Acyanotic lesionsMembers
  • 4.5Cyanotic lesionsMembers
  • 4.6The duct-dependent collapseA baby who is well at home and then collapses in the first two weeks of life — grey, shocked, acidotic, poorly…Members
  • 4.7Kawasaki diseaseAny child with a fever for five days or more plus features such as conjunctivitis (bilateral, non-purulent), c…Members
  • 4.8Palpitations, syncope and chest painMost childhood chest pain is musculoskeletal and most faints are vasovagal. The features that matter are synco…Members
  • —Common pitfalls · Exam triggersMembers

The core content

Innocent murmurs: the seven S's

An innocent murmur is Soft, Systolic, aSymptomatic, left Sternal edge, Short, with normal heart Sounds, and it varies with poSition, in a child who is otherwise entirely well. Innocent murmurs are common in febrile or anaemic children (high output states) and often disappear when the child sits up or the fever settles.

The rest of this chapter is in the DCH guide

7 more sections, the pitfalls examiners set, and the exam triggers for this topic — written and reviewed by practising UK doctors.

12 guide chaptersDCH question bankPay once, no subscription
Unlock the full DCH guideSign in
← Chapter 3Respiratory

All 12 chapters of the DCH revision guide · DCH question bank