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Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children
Bruno Lefort1,2,3, Elodie Cheyssac4, Nathalie Soulé4
1Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours, France lefort81@gmail.com.
A heart murmur completely disappearing when a child stands up reliably rules out serious cardiac conditions. This simple clinical assessment can prevent unnecessary cardiology referrals and investigations for pediatric patients.
Area of Science:
- Pediatric Cardiology
- Clinical Diagnostics
- Echocardiography
Background:
- Differentiating innocent from pathologic heart murmurs in children can be challenging.
- Unnecessary cardiology referrals and investigations are common due to diagnostic uncertainty.
Purpose of the Study:
- To test if a murmur's complete disappearance upon standing can exclude cardiac disease in children.
- To evaluate the diagnostic utility of positional changes in heart murmur assessment.
Main Methods:
- Prospective study of 194 children (aged 2-18 years) with heart murmurs.
- Murmur characteristics assessed in supine and standing positions.
- Echocardiography performed for definitive diagnosis.
Main Results:
- 15% of children had pathologic heart murmurs.
- Among murmurs disappearing when standing, 98% had a high positive predictive value for excluding pathology.
- Positional change demonstrated high specificity (93%) but lower sensitivity (60%) for pathologic murmurs.
Conclusions:
- Complete disappearance of a heart murmur on standing is a reliable indicator for ruling out pathologic murmurs in children aged 2 and above.
- This bedside clinical maneuver can significantly reduce unwarranted referrals to pediatric cardiologists.
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