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Heart murmur- when to refer for Echocardiogram

A murmur heard during examination nature of the murmur family history age ( especially if > 75 OR medical history (for e.g h/o atrial fibrillation ) Consider an echocardiogram for adults with murmur & no other signs or symptoms if valve disease is suspected based on above.


signs ( such as peripheral oedema ) or symptoms ( as angina and breathlessness ) or an abnormal ECG OR an ejection systolic murmur with a reduced 2nd HS but no other signs or symptoms , Offer an echocardiogram to adults with a murmur if valve disease is suspected 
(based on the nature of murmur , family history , age or medical history ) + above


systolic murmur and exertional syncope murmur and severe symptoms 
( as angina or breathlessness on minimal exertion or at rest ) thought to be related to valvular heart disease . Valvular heard disease is suspected based on the nature of the murmur , family history , age or medical history. Urgent 2 week specialist 
assessment that includes Echo
 or if not available an urgent Echo alone.

Reference Heart valve disease presenting in adults: investigation and management NICE guideline [NG208]Published: 




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