Criteria for Referral toPediatric Cardiologists
Criteria for Referral toIt has become customary for a primary-care physician practicing in a community without a pediatric cardiologist to obtain a 2D echo Doppler in any infant, child or adolescent with a heart murmur and send the videotape to a pediatric cardiologist for review.
This practice should be discouraged for several reasons.
1. The cost is very high.
2. Potentially erroneous interpretation of a technically poor study.
3. Lack of communications with the child's parents who will have many questions.
Your should refer to a pediatric cardiologist all patients with organic murmurs and those in whom you are uncertain. You need not refer patients with obvious functional murmurs (1, 2 and 4 in The Table of Functional Murmurs) except for the pulmonic ejection murmur 3, which is more difficult to assess as it resembles that of an atrial septal defect.
For physicians who practice in a distant community, consultation with a specialist
may be provided through telemedicine. We have shown that telecardiac auscultation
by competent pediatric cardiologists is a satisfactory alternative to hands-on
examination for distinguishing functional from organic murmurs in children
and adolescents.