Paediatric heart murmur: a case series study

Abstract

Introduction: Heart murmurs are detected in many children. They are a common cause of referral and it is important to be aware of the warning signs for significant murmurs when evaluating a child with a heart murmur. Purpose: To analyze the population referred to a Pediatric Cardiology Department with a cardiac murmur. Material and Methods: This is a study of a case series of children referred for investigation of a cardiac murmur. The authors reviewed the cases referred between January to March 2012 with the diagnosis of heart murmur, assessing demographic data, clinical history, physical findings, and the results of laboratory tests, including transthoracic echocardiography and electrocardiography. Results: During the study period, there were a total of 743 first consultations. In 197 children (26.5%) a heart murmur was the reason for referral. Of the sample, 51.3% were male and the majority (about 70%) of patients were younger than 2 years. In almost all of the children the murmur was described as innocent and there were no other significant finding on physical examination. In about one third of cases, anomalies were found with echocardiographic assessment. There was a significant association between a non-innocent murmur and abnormal findings on physical examination and echocardiography. There was also a significant association between important murmurs and age less than one year with ultrasound findings. Discussion: Cardiac murmurs in children are a frequent reason for referral. Most murmurs in children are benign. Clinical features allow for differentiation between innocent and pathological murmurs. As described in previous studies, abnormalities found on physical examination and younger ages are warning signs that require a more detailed evaluation.