[Initial assessment of heart murmurs in children: role of complementary diagnostic tests]

Heart murmur, most of them innocent, are the most common reason for referrals to a pediatric cardiologist.

The objective of this study was to analyse the utility of the electrocardiogram (ECG) and echocardiography in the initial assessment of heart murmurs in an asymptomatic pediatric population.

For each of 170 consecutive children who were seen for first time evaluation of a heart murmur, the clinical diagnosis was registered and the patients were classified as having innocent murmur (IM), pathologic murmur (PM), or possible pathologic murmur (PPM). The results of ECG and echocardiogram two-dimensional/Doppler were registered and changes in diagnosis were recorded and compared with the original impressions.

After ECG no diagnosis was changed. After two-dimensional/Doppler echocardiogram the clinical diagnosis of innocent murmur in 118 children was changed to pathologic in one (one trivial pulmonary stenosis); pathologic murmurs in 43 children was changed to innocent in two; and possible pathologic in nine children was changed to innocent in six and possible pathologic in three. The clinical examinations had a sensitivity of 97.6%, specificity of 93.6%, positive predictive value of 95.3%, and negative predictive value of 99.1%.

Clinical assessment by a Pediatric Cardiologist is sufficient to distinguish pathologic from innocent heart murmurs. Echocardiography, although diagnostic when heart disease is suspected, is unnecessary in a pediatric patient with clinically diagnosed innocent murmur.