Potential recruits referred for cardiac opinion review of 100 consecutive cases--a waste of time or an investment?

Eighty seven of 100 consecutive recruits referred for cardiac assessment of fitness to serve had heart murmurs. Seven of these were rejected as having significant cardiac disease. One with a diagnosis of hypertrophic cardiomyopathy would have been placed at considerable risk had he been exposed to the physical stress of military training. The remaining 6 rejected had conditions which could have been worsened by the stress of military training and/or required intensive cardiac follow-up. These included 3 individuals with aortic regurgitation, 1 with atrial septal defect, 1 with ventricular septal defect combined with a small atrial septal defect and 1 with post rheumatic fever mitral regurgitation. Thirteen patients we assessed because of other cardiac problems including repaired congenital heart disease and hypertension. The rejection rate in this group was high at 10 out of 13. The majority of those referred (83/100) were found to be fit for military service. Five of these required advice on antibiotic prophylaxis but the majority had totally unrestricted service. Although most recruits who present with cardiac "problems" will be fit for service, important and potentially fatal conditions can be detected. Therefore vigilance must be high amongst examining doctors and suspect individuals referred for appropriate assessment.