RT Journal Article
SR Electronic
T1 Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 523
OP 528
DO 10.1370/afm.2105
VO 15
IS 6
A1 Bruno Lefort
A1 Elodie Cheyssac
A1 Nathalie Soulé
A1 Jacques Poinsot
A1 Marie-Catherine Vaillant
A1 Alaeddin Nassimi
A1 Alain Chantepie
YR 2017
UL http://www.annfammed.org/content/15/6/523.abstract
AB 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.