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Evaluation of children with heart murmurs
1Division of Pediatric Cardiology, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Insights
Most childhood heart murmurs are innocent, not serious heart conditions. Primary care clinicians can differentiate innocent murmurs from pathologic ones using history and physical exam skills, focusing on common innocent murmur types.
Area of Science:
- Pediatric Cardiology
- Primary Care Medicine
- Diagnostic Skills
Background:
- Heart murmurs are common in children aged 6 months to 15 years.
- Most murmurs in this age group are innocent, with congenital heart disease being rare.
- Distinguishing innocent from pathologic murmurs is a crucial task for primary care clinicians.
Purpose of the Study:
- To equip primary care clinicians with the skills to differentiate innocent from pathologic heart murmurs.
- To provide a framework for competent and cost-effective murmur assessment in children.
Main Methods:
- Utilizing patient history and physical examination techniques.
- Familiarization with the characteristics of the five most common innocent heart murmurs.
Main Results:
- Innocent heart murmurs are prevalent in children aged 6 months to 15 years.
- Specific innocent murmur types include vibratory (Still's) murmur, pulmonary flow murmur, peripheral pulmonary artery stenosis murmur, supraclavicular arterial bruit, and venous hum.
Conclusions:
- Primary care clinicians can effectively distinguish innocent from pathologic murmurs through targeted history and physical exam skills.
- Knowledge of common innocent murmur characteristics aids in accurate and efficient diagnosis, reducing unnecessary referrals and healthcare costs.
Abstract:
Most of the murmurs that are detected in children between the ages of 6 months and 15 years are of the innocent type. Given the high prevalence of murmurs in this population coupled with the low occurrence of congenital heart disease, distinguishing innocent from pathologic murmur is a frequent and important task for the primary care clinician. The primary care clinician can develop the necessary skills to distinguish between the innocent heart murmurs and pathologic murmurs using history and physical examination skills. Becoming familiar with the characteristics of the five most common innocent heart murmurs, which are (1) vibratory or Still's murmur, (2) pulmonary flow murmur, (3) peripheral pulmonary artery stenosis murmur, (4) supraclavicular arterial bruit murmur, and (5) venous hum, will assist the primary care clinician in accomplishing this task in a competent and cost-effective manner.