Document type
Clinical pathways
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
Diagnosing Asymptomatic Heart Murmur

Diagnosing Asymptomatic Heart Murmur

If incidental finding of asymptomatic heart murmur, not previously investigated:

  • Cardio-vascular examination including ECG
  • Routine blood tests not necessary unless clinical indication e.g. anaemia - FBC, (see pathway)

Summary of where and when to refer

  • If suspect co-exisiting heart disease - refer to cardiology
  • If no suspicion of co-existing heart disease - refer if thought to be cardiac in origin

Referral to Cardiology clinic:

  • Asymptomatic murmur and suspicion of co-existing heart disease, e.g:
    • Anginal type chest pain 
    • Shortness of breath
    • Pain in neck, jaw, throat, abdomen or back in association with chest pain and sweatiness
    • Known history of coronary heart disease or ischaemic heart disease
    • Syncope associated with palpitations
  • Asymptomatic murmur with moderate/severe abnormality on direct access echo

Include in the cardiology referral:

  • Routine bloods, as appropriate - FBC, U&Es, CRP, TFT, LFT, HbA1c. Consider BNP if signs and symptoms of heart failure
  • History - symptoms and duration, past medical history including cardiac history, drug history, social history, alcohol and drug abuse history.
  • Examination findings- cardiovascular, respiratory, thyroid
  • ECG
  • Most recent echo report