The recent Healthcare Commission report has highlighted wide variations in paediatric services available to children in hospitals across the United Kingdom 1. This is certainly the case for paediatric cardiology services across the East of England. A few hospitals have well developed services provided by full-time paediatricians with an interest in cardiology but in most there is limited expertise. Congenital heart disease (CHD) is common; the anomalies vary in severity, present in very different ways and at different ages. Heart murmurs may be an important presenting sign of an underlying cardiac disorder in infancy and childhood 2. Increasing numbers of asymptomatic children are being referred to specialist paediatric cardiologists 3.