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Heart, Lung & Circulation Feb 2020Innocent murmurs are common in childhood. Echocardiography may diagnose almost all congenital cardiac abnormalities. Earlier studies have suggested that it may be... (Clinical Trial)
Clinical Trial
BACKGROUND
Innocent murmurs are common in childhood. Echocardiography may diagnose almost all congenital cardiac abnormalities. Earlier studies have suggested that it may be unnecessary when a clinical diagnosis of an innocent murmur is made by an experienced cardiologist. Yet, echocardiography is commonly performed despite such a diagnosis. Is that justifiable?
METHODS
Patients referred to a paediatric cardiologist for evaluation of a murmur were assessed. If an innocent murmur was clinically diagnosed, an echocardiogram and an electrocardiogram were ordered when requested. The cardiologist completed a questionnaire documenting the reasons for the investigations and his degree of confidence in the clinical diagnosis. The parents and patients were informed of the diagnosis and the results of the investigations.
RESULTS
In almost all 62 cases whose murmurs were clinically considered to be innocent, the referring doctor expected an echocardiogram to be performed. Following echocardiography, one patient was found to have a small muscular ventricular septal defect. On review, the murmur was consistent with that diagnosis. Three (3) others had abnormal echocardiograms namely congenitally corrected transposition of great arteries, partial anomalous right upper lobe pulmonary vein, and left ventricular non-compaction. All on review were still considered clinically to have innocent murmurs.
CONCLUSIONS
Despite the competency of the cardiologist, echocardiography diagnosed important but relatively uncommon cardiac abnormalities with prognostic implications that would have been missed if only the clinical examination was performed. Over and above the referring doctor's expectations for an echocardiogram to be performed is the need for the cardiologist to provide a complete and definitive diagnosis.
Topics: Child; Child, Preschool; Echocardiography; Female; Heart Defects, Congenital; Heart Murmurs; Humans; Infant; Male; Surveys and Questionnaires
PubMed: 30876810
DOI: 10.1016/j.hlc.2019.02.003 -
British Heart Journal Jan 1980Normal auscultatory findings were studied during a heart survey in which 12 050 Black schoolchildren, aged 2 to 18 years, were examined by cardiologists. Physiological...
Normal auscultatory findings were studied during a heart survey in which 12 050 Black schoolchildren, aged 2 to 18 years, were examined by cardiologists. Physiological third heart sounds were detected in 96 per cent of children, innocent systolic murmurs in 72 per cent, and innocent mid-diastolic murmurs in 0.27 per cent. The term 'innocent systolic murmur" was used for vibratory systolic murmurs (70%) and pulmonary ejection systolic murmurs (4.2%) but distinct separation of these two murmurs was often difficult. Vibratory systolic murmurs were present throughout the age range. Important features in differentiating innocent systolic murmurs from those caused by mild organic heart disease included the intonation, site of maximal intensity, timing in systole, and behaviour with postural change. Innocent mid-diastolic murmurs are short murmurs occurring immediately after the third heart sound in children, with no supportive evidence of organic heart disease.
Topics: Adolescent; Black People; Child; Child, Preschool; Female; Heart; Heart Auscultation; Heart Murmurs; Heart Sounds; Humans; Male; South Africa
PubMed: 7356863
DOI: 10.1136/hrt.43.1.67 -
Mayo Clinic Proceedings Sep 2022
Topics: Echocardiography; Heart Murmurs; Humans; Male
PubMed: 36058583
DOI: 10.1016/j.mayocp.2022.02.032 -
British Heart Journal Jan 1949
Topics: Anemia; Heart Murmurs; Humans
PubMed: 18113477
DOI: No ID Found -
Jornal de Pediatria May 2003To discuss clinical and laboratorial evaluation of heart murmurs in children, an important problem faced by pediatricians in their practice. (Review)
Review
OBJECTIVE
To discuss clinical and laboratorial evaluation of heart murmurs in children, an important problem faced by pediatricians in their practice.
SOURCES
This review was based on a critical analysis of the current literature, as well as pediatrics and pediatric cardiology textbooks, which were found to be an important source of information on the subject.
SUMMARY OF THE FINDINGS
It is important for pediatricians to know how to obtain precise information regarding the patient's medical history and to perform extensive physical examination of a child with heart murmur. The diagnosis of innocent heart murmur is essentially clinical and it can help the pediatrician to identify situations which are associated with cardiovascular diseases.
CONCLUSIONS
The pediatrician is usually the first physician to see a child with heart murmur and he should be able to distinguish between innocent and pathologic heart murmurs.
Topics: Child; Heart Murmurs; Humans
PubMed: 14506521
DOI: 10.2223/jped.1003 -
Journal of the American Veterinary... Nov 2012To determine the prevalence of heart murmurs in chinchillas (Chinchilla lanigera) and determine whether heart murmurs were associated with cardiac disease.
OBJECTIVE
To determine the prevalence of heart murmurs in chinchillas (Chinchilla lanigera) and determine whether heart murmurs were associated with cardiac disease.
DESIGN
Retrospective multi-institutional case series.
ANIMALS
260 chinchillas.
PROCEDURES
Medical records of all chinchilla patients evaluated at the Tufts University Foster Hospital for Small Animals between 2001 and 2009, the University of California-Davis William R. Pritchard Veterinary Medical Teaching Hospital between 1996 and 2009, and the University of Wisconsin Veterinary Medical Teaching Hospital between 1998 and 2009 were reviewed.
RESULTS
Prevalence of heart murmurs was 23% (59/260). Of 15 chinchillas with heart murmurs that underwent echocardiography, 8 had echocardiographic abnormalities, including dynamic right ventricular outflow tract obstruction, mitral regurgitation, hypertrophy of the left ventricle, tricuspid regurgitation, and hypovolemia. Echocardiographic abnormalities were approximately 29 times as likely (OR, 28.7) to be present in chinchillas with a murmur of grade 3 or higher than in chinchillas without a murmur.
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested that heart murmurs are common in chinchillas and that chinchillas with heart murmurs often have echocardiographic abnormalities, with valvular disease being the most common. On the basis of these results, we believe that echocardiography should be recommended for chinchillas with heart murmurs, especially older chinchillas with murmurs of grade 3 or higher. Further prospective studies are needed to accurately evaluate the prevalence of cardiac disease in chinchillas with heart murmurs.
Topics: Animals; Chinchilla; Female; Heart Murmurs; Male; Odds Ratio; Retrospective Studies
PubMed: 23113527
DOI: 10.2460/javma.241.10.1344 -
Advance For Nurse Practitioners Sep 2000
Review
Topics: Auscultation; Child; Heart Murmurs; Humans; Infant; Infant, Newborn; Medical History Taking; Nurse Practitioners; Nursing Diagnosis; Physical Examination
PubMed: 11761547
DOI: No ID Found -
Heart (British Cardiac Society) Jul 2016An asymptomatic 29-year-old woman presented for prenatal counselling. She had a history of a heart murmur since childhood and a previous echocardiogram suggesting...
CLINICAL INTRODUCTION
An asymptomatic 29-year-old woman presented for prenatal counselling. She had a history of a heart murmur since childhood and a previous echocardiogram suggesting 'enlargement of the heart'. Physical exam revealed normal jugular venous pressure and contour. Precordial palpation was unremarkable. Auscultation, however, was abnormal; findings on inspiration and expiration are presented in Figure 1, sound clip.
QUESTION
Based on the phonocardiogram and online supplementary audio clip, which of the following is correct? An early diastolic filling sound (S3) is heard, indicating increased right ventricular filling pressures.An ejection click without respiratory variation and a systolic ejection murmur are heard, consistent with bicuspid aortic valve stenosis.An ejection click with respiratory variation and a systolic ejection murmur are heard, consistent with pulmonic valve stenosis.A holosystolic murmur with inspiratory augmentation is heard, indicating tricuspid regurgitation.
Topics: Adult; Echocardiography; Electrocardiography; Female; Heart Murmurs; Humans; Phonocardiography; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Care; Pulmonary Valve Stenosis
PubMed: 26919867
DOI: 10.1136/heartjnl-2015-309131 -
Neonatal Network : NN Aug 1999
Topics: Heart Murmurs; Heart Sounds; Humans; Incidence; Infant, Newborn; Infant, Premature, Diseases; Neonatal Nursing; Pulmonary Valve Stenosis
PubMed: 10693479
DOI: 10.1891/0730-0832.18.5.65 -
The Journal of Small Animal Practice Feb 2015To determine the prevalence of physiological heart murmurs in healthy young adult dogs.
OBJECTIVES
To determine the prevalence of physiological heart murmurs in healthy young adult dogs.
MATERIALS AND METHODS
Healthy dogs aged between 1 and 5 years were enrolled prospectively. All participating dogs underwent physical examination, urinalysis, blood testing and blood pressure measurement. Cardiac auscultations were performed by three independent examiners. Dogs with heart murmurs underwent echocardiography, to exclude cardiovascular abnormalities.
RESULTS
Of 109 dogs evaluated, 95 completed the study. Heart murmurs were detected in 22 dogs. Interobserver agreement for murmur detection was moderate to fair (weighted kappa 0 · 29-0 · 56). On the basis of two different sets of echocardiographic criteria, physiological heart murmurs were diagnosed in 6 and 11 dogs, respectively, giving a prevalence of 6-12%. All physiological heart murmurs were systolic and low-grade (I-III/VI). Most were louder towards the left heart base and some radiated up to the thoracic inlet. The epidemiological features of dogs with physiological heart murmurs did not differ significantly from those of dogs without murmurs (P > 0 · 10).
CLINICAL SIGNIFICANCE
This study shows that physiological heart murmurs may not be limited to growing dogs or specific breeds, as they were commonly encountered in this population of healthy young adult dogs.
Topics: Animals; Dog Diseases; Dogs; Echocardiography; Female; Heart Murmurs; Male; Prevalence; Prospective Studies; Species Specificity
PubMed: 25440774
DOI: 10.1111/jsap.12300