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Evaluating cardiac murmurs; are diagnostic tests helpful?

C Macleod1

  • 1Department of Paediatrics, Antrim Area Hospital, Northern Ireland. cmacleod@doctors.org.uk

Irish Medical Journal
|July 28, 2001
PubMed
Summary

Routine chest X-rays (CXRs) and electrocardiographs (ECGs) are not useful for diagnosing asymptomatic pediatric cardiac murmurs. Even with normal CXRs and ECGs, further investigation may be needed for pathological murmurs.

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Area of Science:

  • Pediatric Cardiology
  • Diagnostic Imaging
  • Clinical Decision Making

Background:

  • Asymptomatic cardiac murmurs in children often lead to referrals and diagnostic tests like chest radiography (CXR) and electrocardiography (ECG).
  • The diagnostic utility of CXR and ECG for asymptomatic murmurs is debated, lacking consistent evidence.

Purpose of the Study:

  • To evaluate the diagnostic usefulness of routine chest radiography (CXR) and electrocardiography (ECG) in children presenting with asymptomatic cardiac murmurs.
  • To determine if CXR and ECG aid in differentiating pathological from innocent murmurs in pediatric patients.

Main Methods:

  • Retrospective chart review of 81 children referred for asymptomatic cardiac murmurs over a one-year period.
  • Analysis of CXR and ECG findings in relation to clinical diagnosis and subsequent echocardiogram results.

Main Results:

  • All patients with a clinical diagnosis of pathological murmur had normal CXR and ECG findings.
  • Two cases with pathological murmurs were diagnosed with structural heart disease via echocardiogram, despite normal initial investigations.
  • In patients with innocent murmurs, 81% underwent CXR and ECG, with 96% showing normal results; abnormal findings did not correlate with structural heart disease.

Conclusions:

  • Routine use of chest radiography (CXR) and electrocardiography (ECG) is not beneficial for evaluating asymptomatic cardiac murmurs in children.
  • Diagnostic imaging and electrocardiography do not reliably identify or rule out significant cardiac pathology in this patient group.

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