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Paeds Casescardiology

Paeds Cases · cardiology

Explaining a heart murmur to a family — OSCE

OSCE communication and shared decision-making station: explaining to the parents of a thriving four-year-old boy what the soft heart murmur found at a routine check means, how the examination showed it was innocent, why no echocardiogram is needed, what the family should watch for, and how the school and activity will be supported — while addressing fear, the search for reassurance, and the question of whether something has been missed.

osce communication and shared decision-making3 min readVerification in progress

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
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Study tools

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A four-year-old boy sits with his parents in the outpatient clinic. His general practitioner heard a heart murmur at a routine check and referred him for reassurance. He is thriving, fully active and asymptomatic. Your examination shows a soft, short, vibratory systolic murmur at the lower left sternal edge that softens when he sits forward, with normal heart sounds, normal pulses, a normal four-limb blood pressure and a normal oxygen saturation. His parents are frightened by the word murmur, worried that something has been missed, and have read about congenital heart disease and surgery online. Counsel them.

Task

Counsel the parents. You have five minutes. Demonstrate an organised, empathic and accurate explanation that addresses the four questions a fellowship communication station rewards: what the murmur is and why it is not a disease, how you know it is innocent rather than something serious, what the plan is (including why a scan is not needed), and what the family should watch for. The management framework follows the published evaluation of heart murmurs in children. [1]

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References3ShowHide
  1. [1]Ford B, Lara S, Park J. Heart Murmurs in Children: Evaluation and Management. Am Fam Physician, 2022.PMID 35289571
  2. [4]Hueckel RM, Leyland C. Pediatric Murmurs. Nurs Clin North Am, 2023.PMID 37536793
  3. [7]Dalal NN, Dzelebdzic S, Frank LH, et al. Recurrent Cardiology Evaluation for Innocent Heart Murmur: Echocardiogram Utilization and Costs. Clin Pediatr (Phila), 2018.PMID 29993270
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