Detection of congenital heart disease (CHD) remains the main focus in the screening of childhood cardiac conditions. History taking and physical examination form the backbone of this screening process. Referral to a paediatric cardiologist is required for diagnosis and management. There is a need to understand which referrals are urgent. Increasingly, the primary care clinician will encounter the growing pool of post-operative CHD and will need to be familiar with the potential morbidities of this group. Kawasaki Disease is the most common acquired childhood cardiac condition. There should be a high index of suspicion in a child with prolonged fever and a constellation of rash, conjunctivitis, mucositis, dactylitis and cervical lymphadenopathy. Timely diagnosis and treatment prevent coronary artery complications. The primary care physician should also be on the alert to recognise children with cardiac arrhythmias, acute myocarditis, cardiomyopathies and valvular heart disease. Other rare conditions include idiopathic pulmonary arterial hypertension. Screening for risk factors for sudden cardiac death may also be important, particularly for children involved in competitive sports. Primary prevention of coronary artery disease and metabolic syndrome starts in childhood. The “at-risk” child should be identified early and healthy lifestyle and diet promoted.