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Suspected heart disease in infants and children: Criteria for referral

Stuart Berger, MD
Section Editors
David R Fulton, MD
Martin I Lorin, MD
Deputy Editor
Carrie Armsby, MD, MPH


Although the majority of children with serious congenital heart disease (CHD) are diagnosed prenatally or during the neonatal period, CHD and acquired heart disease present beyond this time period.

The signs and symptoms that lead clinicians to suspect heart disease in infants and children as well as the criteria for referral to a pediatric cardiologist will be reviewed here. The approach to identifying newborns with critical CHD and the approach to assessing infants and children with cardiac murmurs are discussed separately. (See "Identifying newborns with critical congenital heart disease" and "Approach to the infant or child with a cardiac murmur".)

Individual cardiac conditions are also discussed separately. (See appropriate topic reviews).


Although somewhat obvious, the urgency of referral depends on the clinical condition of the patient and the seriousness of the underlying diagnosis that may be suspected.

Cardiac disease accounts for a significant number of sudden unexpected deaths in children. In a retrospective review of all autopsies performed at a tertiary Canadian hospital, approximately 2 percent of deaths were due to sudden unexpected cardiac death [1]. Of the 103 cases, chart review showed that one-fourth had documented premonitory symptoms. The diagnoses and their relative frequency included the following:

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Literature review current through: Oct 2017. | This topic last updated: Mar 23, 2017.
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