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Approach to a child with a heart murmur

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Abstract

The vast majority of children with heart murmurs have an ‘innocent’ murmur. Differentiation of such murmurs from those due to structural cardiac disease, so called ‘pathological’ murmurs, is largely clinical. Pediatricians are capable of differentiating one from the other, provided a detailed evaluation is done. This article outlines the salient features of innocent murmurs that help us recognize them clinically.

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References

  1. Pelech AN. The cardiac murmur. When to refer ?Pediatr Clin N Am 1998; 45(1): 107–122.

    Article  CAS  Google Scholar 

  2. Wiles HB, Saul JP. Pediatric cardiac auscultation.Journal-South Carolina Medical Association 1999; 95(10): 375–378

    PubMed  CAS  Google Scholar 

  3. Wren C. Technological advances and assessment of children with murmurs.Arch Dis Child 2002; 87 (4): 300–301.

    Google Scholar 

  4. Amaral F, Granzoth JA. Cardiologic evaluation of children with suspected heart disease: experience of a public outpatient clinic in Brazil.Sao Paulo Med J 1999; 117(3) : 101–107.

    Article  PubMed  CAS  Google Scholar 

  5. Asprey DP. Evaluation of children with heart murmurs.Lippincot’s Primary Care Practice 1998; 2(5): 505–513.

    CAS  Google Scholar 

  6. Rein AJ, Omokhodion SI, Nir A. Significance of a cardiac murmur as the sole clinical sign in the newborn.Clin Pediatr (Phila) 2000; 39 (9): 511–520.

    Article  CAS  Google Scholar 

  7. Still GR. Common disorders and diseases of childhood. London, Frowde, Hodder & Stoughton, 1915; p 495

    Google Scholar 

  8. Stein PD, Sabbah HN. Aortic origin of innocent murmurs.Am J Cardiol 1977; 39: 665

    Article  PubMed  CAS  Google Scholar 

  9. Perry LW, Ruckman RN, Shapiro SRet al. Left ventricular false tendons in children: Prevalence as detected by 2 — dimensional echocardiography and clinical significance.Am J Cardiol 1983; 52 :1264–1266

    Article  PubMed  CAS  Google Scholar 

  10. Perloff JK. Innocent murmurs.The Clinical Recognition of Congenital Heart Disease. 4th edn. Philadelphia, WB Saunders, 1994; p. 9–20.

    Google Scholar 

  11. Potain SC. Des mouvements et des bruits qui se paseent dans les veines jugulaires.Bull Mem Soc Med Hop Paris 1867; 4:3.

    Google Scholar 

  12. Cutforth R, Wiseman J, Sutherland RD. The genesis of the cervical venous hum.Am Heart J 1970; 80:488.

    Article  PubMed  CAS  Google Scholar 

  13. Nadas AS. Approach to diagnosis of congenital heart disease without recourse to special diagnostic tests.Circulation 1959; 20:602.

    PubMed  CAS  Google Scholar 

  14. McCrindle BW, Shaffer KM, Kan JSet al. Cardinal clinical signs in the differentiation of heart murmurs in children.Arch Pediatr Adolesc Med 1996; 150:169–174.

    PubMed  CAS  Google Scholar 

  15. McConnell ME, Adkins SB, Hannon DW. Heart murmurs in pediatric patients: when do you refer?Am Fam Physician 1999;60(2): 558–565.

    PubMed  CAS  Google Scholar 

  16. Rajakumar K, Weisse M, Rosas Aet al. Comparative study of clinical evaluation of heart murmurs by general pediatricians and pediatric cardiologists.Clinic Pediatr 1999; 38(9): 511–518.

    CAS  Google Scholar 

  17. Newburger JW, Rosenthal A, Williams RG, Fellows K, Miettinen OS. Noninvasive tests in the initial evaluation of heart murmurs in children.N Engl J Med 1983; 308: 61–64.

    Article  PubMed  CAS  Google Scholar 

  18. Geva T, Hegesh J, Trand M. Reaprrisal of the approach to the child with heart murmurs. Is echocardiograhy mandatory?Int J Cardiol 1988; 19:107–113.

    Article  PubMed  CAS  Google Scholar 

  19. Smythe JF, Teixeira OHP, Vlad P, Demers PP, Feldman W. Initial evaluation of heart murmurs: are laboratory tests necessary?Pediatrics 1990; 86:497–500.

    PubMed  CAS  Google Scholar 

  20. Haney I, Ipp M, Feldman W, Mc Crindle BW. Accuracy of clinical assessment of heart murmurs by office based (general practice) Pediatricians.Arch Dis Child 1999; 81:409–412.

    Article  PubMed  CAS  Google Scholar 

  21. Birkeback NH, Hansen LK, Elle Bet al. Chest roentgenogram in the evaluation of heart defects in asymptomatic infants and children with a cardiac murmur: reproducibility and accuracy.Pediatrics 1999; 103(2): E 15.

    Google Scholar 

  22. Castello-Hebreteau B, Vaillant MC, Magontier Net al. Diagnostic value of physical examination and electro-cardiogram in the initial evaluation of heart murmurs in children (French).Archives de Pediatrie 2000; 7 (10): 1041–1049.

    Article  Google Scholar 

  23. Danford DA, Gumbiner CH, Martin AB, Fletcher SE. Effects of electrocardiography and chest radiography on the accuracy of preliminary diagnosis of common congenital cardiac defects.Pediatr Cardiol 2000; 21 (4): 334–340.

    Article  PubMed  CAS  Google Scholar 

  24. Dahl LB, Hasvold P, Arild E, Hasvold T. Heart murmurs recorded by a sensor based electronic stethoscope and e-mailed for remote assessment.Arch Dis Child 2002; 87(4): 297–301.

    Article  PubMed  CAS  Google Scholar 

  25. DeGroff CG, Bhatikar S, Hertzberg Jet al. Artificial neural network-based method of screening heart murmurs in children.Circulation 2001; 103(22): 2711–2716.

    PubMed  CAS  Google Scholar 

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Correspondence to Banani Poddar.

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Poddar, B., Basu, S. Approach to a child with a heart murmur. Indian J Pediatr 71, 63–66 (2004). https://doi.org/10.1007/BF02725659

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