Discussed a 18 month old child with complex cyanotic heart condition, operated with central sternotomy scar with a residual murmur.

Learning point:

• Murmur – think of relevant differential diagnosis
• Know the physiology underpinning the anatomical defect.
• Work on presentation and leading on to discussion.
• Think of the findings and work out how they related to each other and over all.
• Put ‘things’ into 1,2 or 3 common causes – if possible.