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Cardiac murmurs in childhood

D Kavanagh-Gray

    Canadian Family Physician Medecin De Famille Canadien
    |February 4, 2011
    PubMed

    Insights

    Clinical skills can differentiate innocent heart murmurs from organic ones. This guide details distinguishing features to avoid unnecessary medical referrals and patient concern.

    Area of Science:

    • Cardiology
    • Pediatric Cardiology

    Background:

    • Distinguishing innocent heart murmurs from pathological organic murmurs is crucial in clinical practice.
    • Misdiagnosis can lead to unnecessary patient anxiety and referrals.

    Purpose of the Study:

    • To outline clinical methods for differentiating innocent heart murmurs from various organic murmurs.
    • To provide clinicians with tools for accurate diagnosis using only clinical skills.

    Main Methods:

    • Differentiation based on the behavior of the second heart sound.
    • Assessment of murmur length, radiation, and response to specific maneuvers.
    • Utilizing blood pressure recordings for specific murmur types.

    Main Results:

    • Pulmonary flow murmurs distinguished from atrial septal defect/pulmonary stenosis by second heart sound.
    • Parasternal vibratory murmurs differentiated from ventricular septal defect.
    • Venous hums identified and separated from patent ductus arteriosus.
    • Supraclavicular murmurs distinguished from carotid bruit, aortic stenosis, and coarctation.

    Conclusions:

    • Clinical skills are sufficient for identifying innocent heart murmurs.
    • Accurate differentiation obviates unnecessary patient concern and referrals.
    • A systematic approach using auscultation and simple maneuvers aids diagnosis.

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