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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.
Insights
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.
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.
Abstract:
In a sample of 256 children referred to the São Paulo Hospital for consultation because of heart murmurs the incidence of innocent murmur was 41%. A clinical history and physical examination was performed in every child. The diagnosis was confirmed without the use of laboratory tests in only 5.5% of the cases: 32% of the children were submitted to chest x-ray and electrocardiogram; an echocardiogram had to be performed in 61% of the children and in 1.1% the catheterism was necessary to make the diagnosis. In the great majority of children with high suspicion of innocent murmur a good history and physical examination will suffice to confirm the diagnosis. If heart disease is suspected, laboratory tests should be performed for further evaluation. Any physician should be able to distinguish between pathologic and innocent murmurs based on their clinic features. The authors present a short review about the subject.