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Research ArticleOriginal ResearchA

Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children

Bruno Lefort, Elodie Cheyssac, Nathalie Soulé, Jacques Poinsot, Marie-Catherine Vaillant, Alaeddin Nassimi and Alain Chantepie
The Annals of Family Medicine November 2017, 15 (6) 523-528; DOI: https://doi.org/10.1370/afm.2105
Bruno Lefort
1Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours, France
2University François Rabelais, Tours, France
3INSERM UMR 1069 - Nutrition, Croissance et Cancer, Tours, France
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  • For correspondence: lefort81@gmail.com
Elodie Cheyssac
1Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours, France
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Nathalie Soulé
1Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours, France
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Jacques Poinsot
1Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours, France
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Marie-Catherine Vaillant
1Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours, France
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Alaeddin Nassimi
4University Hospital Centre of Poitiers, Poitiers, France
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Alain Chantepie
1Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours, France
2University François Rabelais, Tours, France
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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.

  • heart murmur
  • heart defects
  • congenital
  • children
  • auscultation
  • primary care
  • practice-based research

Footnotes

  • Conflicts of interest: authors report none.

  • Received for publication January 10, 2017.
  • Revision received March 23, 2017.
  • Accepted for publication April 11, 2017.
  • © 2017 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 15 (6)
The Annals of Family Medicine
Vol. 15, Issue 6
November/December 2017
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Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children
Bruno Lefort, Elodie Cheyssac, Nathalie Soulé, Jacques Poinsot, Marie-Catherine Vaillant, Alaeddin Nassimi, Alain Chantepie
The Annals of Family Medicine Nov 2017, 15 (6) 523-528; DOI: 10.1370/afm.2105

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Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children
Bruno Lefort, Elodie Cheyssac, Nathalie Soulé, Jacques Poinsot, Marie-Catherine Vaillant, Alaeddin Nassimi, Alain Chantepie
The Annals of Family Medicine Nov 2017, 15 (6) 523-528; DOI: 10.1370/afm.2105
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