Murmur

1.  If reliable history available from a guardian, pediatrician, or cardiologist indicates the murmur is innocent, proceed.  The anesthesiologist need not be consulted.

2.  If the pathology is minor and stable (e.g. small VSD), the case may proceed even if the patient is due for follow up.  The anesthesiologist may be consulted.

3. If the murmur is pathologic of a major deformity but the patient is stable and has an up to date evaluation from a cardiologist, then proceed.  Consult the anesthesiologist.

4.  The patient with major pathology who has new or changing symptoms, even if the cardiology note is up to date, needs to see the cardiologist to resolve the treatment plan prior to surgery.  If the note is not up to date, the patient must see the cardiologist prior to surgery.  Consult the anesthesiologist.