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Heart murmur in pediatrics: innocent or pathologic?

D S Castellotti¹, A Makssoudian, M C Mendes

¹Department of Pediatrics, Paulista Medical School, São Paulo.

Revista Paulista De Medicina

|January 1, 1992

Summary

In children with heart murmurs, a clinical history and physical exam diagnosed innocent murmurs in 41%. Further diagnostic tests like echocardiograms were often needed for definitive diagnosis in suspected heart disease cases.

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Area of Science:

Pediatric Cardiology
Diagnostic Accuracy

Background:

Heart murmurs are common in children, necessitating accurate differentiation between innocent and pathological causes.
Distinguishing innocent murmurs from those indicative of heart disease is crucial for appropriate patient management.

Purpose of the Study:

To determine the incidence of innocent murmurs in children referred for cardiac evaluation.
To assess the diagnostic utility of clinical history and physical examination versus instrumental tests for diagnosing heart murmurs in pediatric patients.

Main Methods:

Retrospective analysis of 256 children referred to São Paulo Hospital for heart murmur evaluation.
Clinical history and physical examination were performed for all children.
Diagnostic procedures included chest X-ray, electrocardiogram, echocardiogram, and cardiac catheterization as indicated.

Main Results:

The incidence of innocent murmurs was 41% in the study sample.
Clinical history and physical examination alone confirmed the diagnosis in only 5.5% of cases.
Echocardiography was required in 61% of children, and cardiac catheterization in 1.1% for diagnosis.

Conclusions:

A thorough clinical history and physical examination are often sufficient to diagnose innocent murmurs in children.
Instrumental diagnostic tests, particularly echocardiography, are frequently necessary for definitive diagnosis, especially when heart disease is suspected.
Physicians must be skilled in differentiating between innocent and pathological murmurs based on clinical features.

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