Bruno Lefort1,2,3, Elodie Cheyssac4, Nathalie Soulé4, Jacques Poinsot4, Marie-Catherine Vaillant4, Alaeddin Nassimi5, Alain Chantepie4,2. 1. Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours, France lefort81@gmail.com. 2. University François Rabelais, Tours, France. 3. INSERM UMR 1069 - Nutrition, Croissance et Cancer, Tours, France. 4. Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours, France. 5. University Hospital Centre of Poitiers, Poitiers, France.
Abstract
PURPOSE: The distinction between physiologic (innocent) and pathologic (organic) heart murmurs is not always easy in routine practice, leading too often to unnecessary cardiology referrals and expensive investigations. We aimed to test the hypothesis that the complete disappearance of murmur on standing can exclude cardiac disease in children. METHODS: From January 2014 to January 2015, we prospectively included 194 consecutive children aged 2 to 18 years who were referred for heart murmur evaluation to pediatric cardiologists at 2 French medical centers. Heart murmur characteristics while supine and then while standing were recorded, and an echo-cardiogram was performed. RESULTS: Overall, 30 (15%) of the 194 children had a pathologic heart murmur as determined by an abnormal echocardiogram. Among the 100 children (51%) who had a murmur that was present while they were supine but completely disappeared when they stood up, only 2 had a pathologic murmur, and just 1 of them needed further evaluation. Complete disappearance of the heart murmur on standing therefore excluded a pathologic murmur with a high positive predictive value of 98% and specificity of 93%, albeit with a lower sensitivity of 60%. CONCLUSIONS: Disappearance of a heart murmur on standing is a reliable clinical tool for ruling out pathologic heart murmurs in children aged 2 years and older. This basic clinical assessment would avoid many unnecessary referrals to cardiologists.
PURPOSE: The distinction between physiologic (innocent) and pathologic (organic) heart murmurs is not always easy in routine practice, leading too often to unnecessary cardiology referrals and expensive investigations. We aimed to test the hypothesis that the complete disappearance of murmur on standing can exclude cardiac disease in children. METHODS: From January 2014 to January 2015, we prospectively included 194 consecutive children aged 2 to 18 years who were referred for heart murmur evaluation to pediatric cardiologists at 2 French medical centers. Heart murmur characteristics while supine and then while standing were recorded, and an echo-cardiogram was performed. RESULTS: Overall, 30 (15%) of the 194 children had a pathologic heart murmur as determined by an abnormal echocardiogram. Among the 100 children (51%) who had a murmur that was present while they were supine but completely disappeared when they stood up, only 2 had a pathologic murmur, and just 1 of them needed further evaluation. Complete disappearance of the heart murmur on standing therefore excluded a pathologic murmur with a high positive predictive value of 98% and specificity of 93%, albeit with a lower sensitivity of 60%. CONCLUSIONS: Disappearance of a heart murmur on standing is a reliable clinical tool for ruling out pathologic heart murmurs in children aged 2 years and older. This basic clinical assessment would avoid many unnecessary referrals to cardiologists.
Authors: Jasminka M Vukanovic-Criley; Stuart Criley; Carole Marie Warde; John R Boker; Lempira Guevara-Matheus; Winthrop Hallowell Churchill; William P Nelson; John Michael Criley Journal: Arch Intern Med Date: 2006-03-27
Authors: Mukul Misra; Mahim Mittal; A M Verma; Rajendra Rai; Gyan Chandra; D P Singh; Rahul Chauhan; Vijay Chowdhary; R P Singh; A K Mall; Mohd J Khan; Suyash Khare; K B Yadav; Rajendra Kumar; A R Aeron; Pramod K Verma Journal: Indian Heart J Date: 2009 Jan-Feb