Related Experiment Videos
[Functional heart murmur and echocardiography: a solved problem?]
M T Manes1, C Pintaudi, M Balsano
1Divisione di Medicina Interna PO. Rogliano, Azienda Ospedaliera, Cosenza.
Insights
Echocardiography is still valuable for diagnosing pediatric murmurs. Even in cases initially suspected as functional, cardiac ultrasound can reveal underlying pathologies, aiding complete patient assessment.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
Background:
- The necessity of echocardiography for differentiating functional pediatric murmurs is questioned.
- Auscultatory cardiac murmurs are common in children, requiring accurate diagnosis.
Purpose of the Study:
- To evaluate the role of echocardiography in the differential diagnosis of pediatric murmurs.
- To determine if echocardiography is necessary for clinically diagnosed functional murmurs.
Main Methods:
- 260 children (1-84 months) with cardiac murmurs underwent clinical evaluation and instrumental assessment (ECG, echocardiography).
- Two pediatric cardiologists independently assessed all children.
- Data were analyzed to compare clinical diagnosis with instrumental findings.
Main Results:
- Echocardiography identified pathology in 15 of 210 children initially diagnosed with functional murmurs (e.g., PFO, ASD, bicuspid aortic valve).
- ECG showed changes in only one patient with a pathological murmur.
- Echocardiography demonstrated high diagnostic accuracy: sensitivity 75%, specificity 97%, PPV 90%, NPV 92%.
Conclusions:
- Echocardiography remains crucial for the comprehensive assessment of pediatric murmurs, even those presumed functional.
- The study suggests performing echocardiography for a complete evaluation in children with functional murmurs.
- Diagnostic imaging aids in identifying subtle cardiac abnormalities not detected by auscultation alone.
Background:
Is it really vanished the need for echocardiography in the differential diagnosis of functional pediatric murmurs?
Methods:
To this aim 260 children (132 males, 128 females; age range 1-84 months) were examined with auscultatory cardiac murmur. All children underwent a clinical and instrumental evaluation (ECG and echocardiography) from two pediatric cardiologists with independent assessment.
Results:
Two hundred and ten patients (Group A) were evaluated clinically with functional murmur, 45 patients (Group B) with pathological murmur, 5 patients (Group C) with uncertain pathology. ECG showed changes in 1 Group B patient. Echocardiography showed pathology in 15 Group A patients (6 patients with patent foramen ovale, 5 patients with interatrial defect, 2 patients with bicuspid aortic valve, 1 patient with mitral insufficiency, 1 patient with restrictive cardiomyopathy). Pathology was excluded in 3 Group B patients, and in 2 Group C patients. In our clinical analysis echocardiography showed sensitivity 75%, specificity 97%, positive predictive value 90%, and negative predictive value 92%.
Conclusions:
In our experience we suggest to perform echocardiographic examination in children with functional murmur for complete assessment.