YEAR 05 • ADVANCED CLINICAL

Paediatrics

20 learning units • 100 chapter sections • 200 explained questions. Assess children from birth through adolescence, recognise urgent illness and plan safe treatment, prevention and family-centred follow-up.

Original RAHBAR study material for the Year 5 learning pathway. Clinical cases support supervised undergraduate learning. Treatment choices, doses and procedures must follow current local protocols and the responsible clinical team. References & further reading ↓

MODULE 13 / 20

Congenital Heart Disease & Cardiac Symptoms

Recognise cardiac presentations and distinguish urgent findings from uncomplicated murmurs.

Quick revision ↓ Medical Dictionary

01Recognise cardiac illness

Ask about feeding fatigue, sweating, poor growth, cyanosis, exercise intolerance and syncope. Infants with heart failure may present primarily with tachypnoea or feeding difficulty. A murmur may be absent in serious disease, so do not use auscultation alone to exclude a cardiac cause.

02Examine systematically

Assess perfusion, pulses, respiratory state, liver size and heart sounds using age-appropriate interpretation. Check femoral pulses and oxygenation where relevant. Abnormal pulse patterns or persistent central cyanosis require timely investigation; a normal single examination cannot exclude every structural lesion.

03Murmur assessment

Describe timing, intensity, radiation and associated findings. Some murmurs are innocent, but symptoms, abnormal heart sounds, cyanosis or poor growth change the risk assessment. Do not reassure solely because a murmur is quiet, and do not diagnose the exact lesion from intensity alone.

04Deteriorating infant

A newborn with shock or cyanosis may have critical congenital heart disease as well as infection or respiratory disease. Obtain urgent neonatal and cardiac expertise while supporting physiology. Definitive diagnosis and specialised treatments require an experienced team; routine outpatient referral is inadequate for instability.

05Follow-up and activity

Children with established disease need individual follow-up, medicine review and advice about activity and procedures. Assess exertional syncope, chest pain with concerning features and a family history of sudden death carefully. Encourage appropriate participation while following specialist restrictions rather than imposing blanket inactivity.

High-Yield Revision

Serious heart disease may occur without a prominent murmur.
Feeding is exercise for an infant.
Exertional syncope warrants careful assessment.

Common Pitfalls

Calling a quiet murmur harmless despite symptoms.
Delaying urgent care in a cyanosed or shocked newborn.

References & Further Reading

Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.

Royal Children’s Hospital — Clinical practice guidelines

Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.