Cardiac murmur

Question:
I have a student having a cardiac murmur. The result of an echo was that he did not have arterial shunting, so no problems are to be expected.
On the other hand it should be wise to start a discussion about the need of a medical examination. The PADI General Standards & Procedures require to fill in the medical questionaire. If no questions are answered with 'Yes' then PADI's statement is that there seems to be no need of a medical examination. If the student decides to let himself examinend, it can be possible that during body investigation a cardiac murmur is found which the student even did not know to have. Any cardiac murmur of a diver should be considered as a cardiac shunt untill proved not to be.
To get rid of these problems it should be reasonable to have anybody medically examined before putting him/her under pressure, but according the PADI General Standards & Procedures this seems not directly necessary.

Answer:
Based on the information above, it is clear that we cannot but always recommend a real pre-dive medical in any case. My personal opinion is that the simple interview may not be sufficient both medically and legally, should things go wrong. In particular a cardiac murmur should not only suggest a cardiological investigation for shunts, but also other conditions related, but not limited to, to valvular and /or arterial disorders.
Furthermore a questionnaire is suitable, if the person answering is sufficiently knowledgeable / aware about his/her health conditions, to report on Symptoms, but would certainly fail to evidentiate a sign of a disease or a condition, such as, for example, a cardiac murmur, a subtle neurological alteration, etcetera.
We are considering this and other related issues at the Diving Committee of the Undersea and Hyperbaric Medical Society, chaired by Drew Rischardson and Michael Lang, and where DAN is represented by Peter Bennett, Hiro Mano and myself and we are discussing the possibilities for a different approach to the matter.