Comparative Study of Clinical Evaluation of Heart Murmurs by General Pediatricians and Pediatric Cardiologists

Abstract

In a study to compare the clinical diagnostic skills of academic general pediatricians and academic pediatric cardiologists in the evaluation of heart murmurs, a total of 128 patients (aged 1 month to 18 years) newly referred to a university pediatric cardiology clinic were evaluated by one of three general pediatricians and one of four pediatric cardiologists. The murmurs were clinically classified as innocent, pathologic, or possibly pathologic. The classification was revised after the review of electrocardiogram (EKG) and chest radiograph (CXR), if indicated. The definitive diagnosis was ascertained by echocardiography (94 normal, 34 abnormal). The general pediatricians identified as many pathologic heart murmurs as the pediatric cardiologists (27/34 vs. 29/34), with no difference in sensitivity, 79% vs. 85% (p = 0.53). The similarity in sensitivity could be because the general pediatricians were more cautious in the classification of heart murmurs and had classified more innocent heart murmurs as pathologic than the pediatric cardiologists (13/39 vs. 3/23), 41% vs. 13% (p = 0.02). The pediatric cardiologists correctly identified more innocent murmurs than general pediatricians (52/94 vs. 72/94), with a better specificity, 55% vs. 76% (p = 0.001); however, the accuracy of prediction of innocence was similar for both groups (52/59 vs. 72/77), 88% vs. 93% (p = 0.36). The revision of diagnosis with review of EKG and CXR was more often misleading than helpful for either group. Academic general pediatricians would identify most of the pathologic murmurs and are no more likely than an academic pediatric cardiologist to misclassify a pathologic heart murmur as innocent.

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

“…Yes No 20 (6) 80 (24) 9 (14) 91 ( (28) 7 (2) 40 (66) 60 ( (12) 57 (16) 80 (53) 20 (13) <.001 (4) 7 (11) 33 (10) 13 (4) 4 (1) 6 (9) 10 (16) 82 (126) 2 ( ogy unit having limited professional resources. 21 Moreover, substantial health care savings would be expected because of the decreased number of consultations and echocardiograms.…”

“…In a few cases, however, the murmur may be the single symptom of cardiac disease, even if most congenital heart diseases are diagnosed before birth or during the first year of life. 1 Differences between physiologic and pathologic murmurs are well known, [4][5][6][7][8][9] but primary care physicians in family medicine or pediatricians too frequently refer their patients to pediatric cardiologists because they fear missing a heart disease diagnosis, resulting in unneeded parental anxiety, time consumption, and expensive evaluations. 10,11 Several clinical features of the murmur such as intensity, timing, quality and pitch, and the presence of a click are subjective and require extensive training for use to distinguish between physiologic and pathologic murmur.…”

The Anxiety Level, Awareness and Expectations from Pediatric Cardiologist of Parents Whose Children Have Been Diagnosed with a Cardiac Murmur During the General Physical Examination

“…Çocukların, kardiyak üfürümleri olduğu söylenerek çocuk kardiyolojisi bölümüne yönlendirilmesi ailelerinde ciddi derecede endişeye neden olmakta ve yapılan çalışmalar göstermiştir ki, çocuk kardiyolojisi uzmanı tarafından muayene edilip, bu üfürümün masum olduğu, bir kalp hastalığı ihtimalinin düşük olduğu belirtilse de ailelerin endişesi devam etmektedir (5,6). Ailelerin büyük çoğunluğu çocuklarda duyulan kalp üfürüm-lerinin çoğunun geçici ve masum karakterli olabileceğini dü-şünmemektedir.…”

Improving the Recognition of Heart Murmur

“…Murmur detection is the cornerstone of diagnosis of congenital heart diseases [1,2]. Efficient detection and delineation of murmurs is important to achieve diagnosis [3].…”