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[Cardiac auscultation in children]
Insights
Cardiac auscultation helps differentiate innocent from pathologic heart murmurs. Pathologic murmurs require further investigation, while innocent murmurs do not necessitate additional tests.
Area of Science:
- Cardiology
- Diagnostic Medicine
Context:
- Cardiac auscultation is a fundamental non-invasive diagnostic tool.
- Differentiating innocent from pathologic heart murmurs is crucial for patient management.
Purpose:
- To review the definition, classification, and evaluation of heart murmurs.
- To outline diagnostic criteria for innocent versus pathologic murmurs.
Summary:
- Pathologic murmurs often present with specific characteristics like holosystolic or diastolic timing, specific locations, and changes with maneuvers.
- Innocent heart murmurs, identified through history and physical exam, do not require further investigation.
- Abnormal findings suggestive of structural heart disease warrant echocardiography.
Impact:
- Provides a framework for accurate heart murmur assessment.
- Guides clinical decision-making, preventing unnecessary investigations for benign conditions.
- Highlights the importance of echocardiography in suspected structural heart disease.
Abstract:
Cardiac auscultation permits to distinguish between the innocent heart murmurs and pathologic murmurs; characteristics of pathologic murmurs include a holosystolic or diastolic murmur, maximal murmur intensity at the upper left sternal border and increased intensity when the patient stands. Murmurs should be described by their timing in the cardiac cycle, intensity, shape, pitch, location, radiation, and response to dynamic maneuvers. When the medical history and physical examination support the diagnosis of innocent heart murmur, neither further investigation nor referal is indicated. On the contrary, echocardiography is recommended for patients with any other abnormal physical examination findings that increase the likelihood of structural heart disease. In this review we discuss the definition and classification of murmurs, how to evaluate it.
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