Prevalence and clinical significance of cardiac murmurs in neonates.
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AIM: To determine the prevalence and clinical significance of murmurs detected during routine neonatal examination. METHODS: In a two year prospective study, 7204 newborn babies underwent routine examination by senior house officers. All those with murmurs underwent echocardiographic examination. All babies presenting later in infancy were also identified, to ascertain the total prevalence of congenital heart disease in infancy. RESULTS: Murmurs were detected in 46 babies (0.6%) of whom 25 had a cardiac malformation. The most common diagnosis was a ventricular septal defect, although four babies had asymptomatic left heart outflow obstruction. A further 32 infants from the same birth cohort had a normal neonatal examination but were found to have a cardiac malformation before 12 months of age. CONCLUSIONS: The neonatal examination detects only 44% of cardiac malformations which present in infancy. If a murmur is heard there is a 54% chance of there being an underlying cardiac malformation. Parents and professionals should be aware that a normal neonatal examination does not preclude a clinically significant cardiac malformation. The detection of a murmur should prompt early referral to a paediatric cardiologist for diagnosis or appropriate reassurance. (+info)
Heart murmurs in pediatric patients: when do you refer?
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Many normal children have heart murmurs, but most children do not have heart disease. An appropriate history and a properly conducted physical examination can identify children at increased risk for significant heart disease. Pathologic causes of systolic murmurs include atrial and ventricular septal defects, pulmonary or aortic outflow tract abnormalities, and patent ductus arteriosus. An atrial septal defect is often confused with a functional murmur, but the conditions can usually be differentiated based on specific physical findings. Characteristics of pathologic murmurs include a sound level of grade 3 or louder, a diastolic murmur or an increase in intensity when the patient is standing. Most children with any of these findings should be referred to a pediatric cardiologist. (+info)
Cardiologic evaluation of children with suspected heart disease: experience of a public outpatient clinic in Brazil.
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CONTEXT: During initial evaluation of children on an outpatient basis, the index of suspected heart disease may be high, particularly if we consider that innocent murmur occurs in about 50% of the pediatric population. This is the most common cause of referral to the pediatric cardiologist. OBJECTIVE: To report on the experience of a public outpatient clinic in the southeastern region of Brazil. DESIGN: Retrospective analysis of all patients submitted to cardiologic evaluation within a 39 month period. SETTING: Public pediatric cardiology outpatient clinic. PARTICIPANTS: 2675 consecutive children aged+info)
Apical systolic click and murmur associated with neurofibromatosis.
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In this report we describe a child who had an apical systolic click and murmur, as well as widespread cutaneous neurofibromatosis. We were not able to show an anatomical basis for the click and murmur. (+info)
Accuracy of clinical assessment of heart murmurs by office based (general practice) paediatricians.
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AIM: To determine the diagnostic accuracy of physical examination by office based (general practice) paediatricians in the evaluation of heart murmurs. DESIGN: Each of 30 office based paediatricians blindly examined a random sample of children with murmurs (43% of which were pathological). Sensitivity and specificity were calculated and were related to paediatricians' characteristics. RESULTS: Mean (SD) sensitivity was 82 (24)% with a mean specificity of 72 (24)% in differentiating pathological from innocent murmurs, with further investigations requested for 54% of assessments. The addition of a referral strategy would have increased mean sensitivity to 87 (20)% and specificity to 98 (8)%. Diagnostic accuracy was not significantly related to the paediatricians' age, education or practice characteristics, but was related to referral practices and confidence in assessment. CONCLUSIONS: Diagnostic accuracy of clinical assessment of heart murmurs by office based paediatricians is suboptimal, and educational strategies are needed to improve accuracy and reduce unnecessary referrals and misdiagnosis. (+info)
A 72 year old woman with ALCAPA.
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ALCAPA syndrome (anomalous origin of the left coronary artery from the pulmonary artery), which causes the left coronary artery to grow with an anomalous origin from the pulmonary artery, is a rare disease which may result in myocardial infarction, congestive heart failure, and sometimes death during the early infantile period. A 72 year old woman with ALCAPA syndrome is presented. The asymptomatic patient presented with a cardiac murmur which was discovered during a routine check up for a gynaecological intervention. Coronary cineangiography established the diagnosis. Although surgical correction is the usual treatment for such cases, medical treatment was preferred for this patient because she was asymptomatic without clinical signs of heart failure. (+info)
Tricuspid aortic valve with partial commissural fusion: prelminary report of an apparently common cause of aortic ejection sounds with potential for serious sequelae, illustrated by two cases.
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We report the cases of 2 patients whose tricuspid aortic valves were found to have partial commissural fusion. Both patients experienced complications that were probably related to this abnormality: bacterial endocarditis in 1 instance and a lacunar stroke in the other. In order to illustrate the similarity of physical findings, we also describe the case of a 3rd patient, who had a typical bicuspid aortic valve. Tricuspid aortic valve with partial commissural fusion has been described in autopsy series and has been predicted to cause an ejection sound, but we could find no previously published description of this lesion in living patients. We wish to alert others to the possible presence of aortic commissural fusion, to its potential for serious and likely preventable sequelae, and to the ability of carefully performed transthoracic high-resolution digital echocardiography to demonstrate this condition when its characteristics are found on physical examination. (+info)
The patient with a systolic murmur: severe aortic stenosis may be missed during cardiovascular examination.
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Significant aortic stenosis is prevalent amongst elderly people. It may be subclinical, manifesting only as a murmur, but can still cause unexpected death with little warning after symptoms develop. Recent studies have highlighted the unreliability of the classical clinical signs of severe aortic stenosis, leading to concern that some patients may not be referred appropriately for echocardiography. Here, we review the evidence for the accuracy of each sign. We suggest that the assessment of the patient with a systolic murmur should be reappraised, and offer guidelines toward improving the recognition of aortic stenosis in the community. (+info)