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Noninvasive tests in the initial evaluation of heart murmurs in children
Insights
Diagnostic tests like electrocardiography and echocardiography rarely change initial diagnoses of no or definite heart disease in children with murmurs. Clinical assessment by a pediatric cardiologist is highly reliable.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging in Cardiology
Background:
- Heart murmurs in children often require diagnostic evaluation.
- Electrocardiography, chest radiography, and echocardiography are commonly used tests.
Purpose of the Study:
- To assess the utility of diagnostic tests in differentiating heart disease in children with murmurs.
- To determine if test results alter initial clinical diagnoses.
Main Methods:
- Prospective study of 280 children over one month old with new heart murmurs.
- Initial clinical categorization (no, possible, definite heart disease) before test review.
- Analysis of diagnostic test impact on initial diagnoses.
Main Results:
- Test results changed diagnoses in 8/142 initially thought to have no heart disease.
- Test results changed diagnoses in 4/34 initially thought to have possible heart disease.
- No diagnoses of definite heart disease were altered by test results.
Conclusions:
- Diagnostic tests have limited impact on initial clinical diagnoses of no or definite heart disease.
- Clinical judgment by pediatric cardiologists is crucial for evaluating pediatric heart murmurs.
- Further investigation may be warranted for 'possible heart disease' cases.
Abstract:
We prospectively examined the usefulness of electrocardiography, chest radiography, and M-mode echocardiography in discriminating between the presence and absence of heart disease in 280 children older than one month and newly referred for evaluation of a heart murmur. After taking a history and performing a physical examination but before reviewing diagnostic tests, we categorized the children as having "no heart disease" (142), "possible heart disease" (34), or "definite heart disease" (104). Among the children initially thought to have no heart disease, the diagnosis was changed after a review of diagnostic tests in eight--three with mitral-valve prolapse, two with possible cardiomyopathy, and three with no heart disease on follow-up. Among those initially thought to have possible heart disease, the tests changed the diagnosis to definite heart disease in four, of whom only one had heart disease (mitral-valve prolapse) on follow-up. In no case did a review of tests change the diagnosis of definite heart disease. We conclude that the results of diagnostic tests are unlikely to change the clinical diagnosis of no heart disease or definite heart disease, when made by a qualified pediatric cardiologist in children newly referred for evaluation of a heart murmur.