Heart murmur screening: Difference between revisions
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{{CMG}} {{AE}} [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]] | {{CMG}} {{AE}} [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]] ,{{nuha}} | ||
{{Heart murmur}} | {{Heart murmur}} | ||
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**History negative for risks of structural heart disease. | **History negative for risks of structural heart disease. | ||
**Characteristic features of innocent murmurs are met. | **Characteristic features of innocent murmurs are met. | ||
* | *The 7S of Innocent Heart Murmurs. <ref name="pmid20488808">{{cite journal| author=Bronzetti G, Corzani A| title=The Seven "S" Murmurs: an alliteration about innocent murmurs in cardiac auscultation. | journal=Clin Pediatr (Phila) | year= 2010 | volume= 49 | issue= 7 | pages= 713| pmid=20488808 | doi=10.1177/0009922810365101 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20488808 }} </ref> | ||
**'''Sensitive''' to change in position and respiration | |||
**'''Short duration''', not holosystolic. | |||
**'''Single''', with no association to gallop or clicks | |||
**'''Small''', limited to one region and does not radiate | |||
**'''Soft''', low amplitude | |||
**'''Sweet''', not harsh | |||
**'''Systolic.''' | |||
*Features of Pathological Murmurs<ref name="pmid14979389">{{cite journal| author=Poddar B, Basu S| title=Approach to a child with a heart murmur. | journal=Indian J Pediatr | year= 2004 | volume= 71 | issue= 1 | pages= 63-6 | pmid=14979389 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14979389 }} </ref><ref name="pmid8673213">{{cite journal| author=Sissman NJ| title=Cardinal clinical signs in the differentiation of heart murmurs in children. | journal=Arch Pediatr Adolesc Med | year= 1996 | volume= 150 | issue= 7 | pages= 771 | pmid=8673213 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8673213 }} </ref><ref name="pmid15275986">{{cite journal| author=Frommelt MA| title=Differential diagnosis and approach to a heart murmur in term infants. | journal=Pediatr Clin North Am | year= 2004 | volume= 51 | issue= 4 | pages= 1023-32, x | pmid=15275986 | doi=10.1016/j.pcl.2004.03.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15275986 }} </ref> | |||
**Holosystolic or diastolic murmur | |||
**Grade 3 of higher murmur | |||
**Harsh quality murmur | |||
**Abnormal S2 | |||
**Peak intensity at upper left sternal border | |||
**Presence of systolic click | |||
**Increased intensity in standing position | |||
*According to the 36th Bethesda Conference in 2005<ref name="pmid15837281">{{cite journal| author=Maron BJ, Douglas PS, Graham TP, Nishimura RA, Thompson PD| title=Task Force 1: preparticipation screening and diagnosis of cardiovascular disease in athletes. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 8 | pages= 1322-6 | pmid=15837281 | doi=10.1016/j.jacc.2005.02.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15837281 }} </ref>, all athletes must undergo pre-participation screening, including a cardiovascular history and physical examination to quality for competitions, in both supine and standing positions to investigate for signs of left ventricular outflow tract obstruction.<ref name="pmid17353433">{{cite journal| author=Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D et al.| title=Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. | journal=Circulation | year= 2007 | volume= 115 | issue= 12 | pages= 1643-455 | pmid=17353433 | doi=10.1161/CIRCULATIONAHA.107.181423 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17353433 }} </ref> | *According to the 36th Bethesda Conference in 2005<ref name="pmid15837281">{{cite journal| author=Maron BJ, Douglas PS, Graham TP, Nishimura RA, Thompson PD| title=Task Force 1: preparticipation screening and diagnosis of cardiovascular disease in athletes. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 8 | pages= 1322-6 | pmid=15837281 | doi=10.1016/j.jacc.2005.02.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15837281 }} </ref>, all athletes must undergo pre-participation screening, including a cardiovascular history and physical examination to quality for competitions, in both supine and standing positions to investigate for signs of left ventricular outflow tract obstruction.<ref name="pmid17353433">{{cite journal| author=Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D et al.| title=Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. | journal=Circulation | year= 2007 | volume= 115 | issue= 12 | pages= 1643-455 | pmid=17353433 | doi=10.1161/CIRCULATIONAHA.107.181423 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17353433 }} </ref> | ||
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Latest revision as of 23:17, 21 January 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, Serge Korjian ,Nuha Al-Howthi, MD[2]
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Overview
Cardiac auscultation is a cost-efficient and relatively sensitive test that should always be performed among all neonatal live births. Additionally, screening for heart murmurs is also recommended among school-children and athletes. While murmurs among neonates are always an indication for further investigation, triage of older children and adolescents according to murmur characteristics is required before referral to a pediatric cardiologist.
Screening
- Screening of the heart murmurs by physical examination, including cardiovascular examination and cardiac auscultation is recommended in all neonates, because congenital heart disease occurs at a rate of 50-75 per 1000 live births.[1][2][3]
- Referral should be made in all cases of murmur auscultation among neonates due to high prevalence of congenital heart disease in this age group.
- Sensitivity and specificity of pathological murmur detection among neonates is considered higher than in older age groups.[4][5]
- Innocent heart murmurs are the most common cause of referral to pediatric cardiologists.
- The risk of pathological murmurs increases with positive family history of cardiac disease, maternal comorbidities during pregnancy, in-utero exposure to medications and alcohol, history of Kawasaki disease or rheumatic fever, and genetic disorders.[6]
- During screening, the most common pathological heart murmurs auscultated in childhood is the murmur of mitral insufficiency, and corresponding to half of pathological murmurs in this age group.[7]
- Screening techniques has been well-validated as an adequate technique to assess for heart diseases in children.
- No further work-up is indicated if the diagnosis of innocent murmurs in children and adolescents made by these 4 criteria:
- No other abnormal physical exam finding
- Negative review of systems
- History negative for risks of structural heart disease.
- Characteristic features of innocent murmurs are met.
- The 7S of Innocent Heart Murmurs. [8]
- Sensitive to change in position and respiration
- Short duration, not holosystolic.
- Single, with no association to gallop or clicks
- Small, limited to one region and does not radiate
- Soft, low amplitude
- Sweet, not harsh
- Systolic.
- Features of Pathological Murmurs[9][10][11]
- Holosystolic or diastolic murmur
- Grade 3 of higher murmur
- Harsh quality murmur
- Abnormal S2
- Peak intensity at upper left sternal border
- Presence of systolic click
- Increased intensity in standing position
- According to the 36th Bethesda Conference in 2005[12], all athletes must undergo pre-participation screening, including a cardiovascular history and physical examination to quality for competitions, in both supine and standing positions to investigate for signs of left ventricular outflow tract obstruction.[13]
- The 2007 American Heart Association (AHA) currently recommends that a standardized history and physical examination, including assessment for heart murmurs, is performed every 2 years for all high school and college students engaged in sports.[13]
- Other athletic groups of different ages do not currently have defined guidelines, but according to AHA, the recommendations of high-school and college athletes may also apply to other age groups.[13]
References
- ↑ Bansal M, Jain H (2005). "Cardiac murmur in neonates". Indian Pediatr. 42 (4): 397–8. PMID 15876611.
- ↑ Rein AJ, Omokhodion SI, Nir A (2000). "Significance of a cardiac murmur as the sole clinical sign in the newborn". Clin Pediatr (Phila). 39 (9): 511–20. PMID 11005364.
- ↑ Ainsworth S, Wyllie JP, Wren C (1999). "Prevalence and clinical significance of cardiac murmurs in neonates". Arch Dis Child Fetal Neonatal Ed. 80 (1): F43–5. PMC 1720873. PMID 10325811.
- ↑ Mackie AS, Jutras LC, Dancea AB, Rohlicek CV, Platt R, Béland MJ (2009). "Can cardiologists distinguish innocent from pathologic murmurs in neonates?". J Pediatr. 154 (1): 50–54.e1. doi:10.1016/j.jpeds.2008.06.017. PMID 18692204.
- ↑ Azhar AS, Habib HS (2006). "Accuracy of the initial evaluation of heart murmurs in neonates: do we need an echocardiogram?". Pediatr Cardiol. 27 (2): 234–7. doi:10.1007/s00246-005-1122-1. PMID 16391989.
- ↑ Frank JE, Jacobe KM (2011). "Evaluation and management of heart murmurs in children". Am Fam Physician. 84 (7): 793–800. PMID 22010618.
- ↑ NALMAN RA, BARROW JG (1964). "HEART DISEASE SCREENING IN SCHOOL CHILDREN. A COMPARISON BETWEEN CLINICAL SCREENING AND HEART-SOUND SCREENING". Circulation. 29: 708–12. PMID 14153942.
- ↑ Bronzetti G, Corzani A (2010). "The Seven "S" Murmurs: an alliteration about innocent murmurs in cardiac auscultation". Clin Pediatr (Phila). 49 (7): 713. doi:10.1177/0009922810365101. PMID 20488808.
- ↑ Poddar B, Basu S (2004). "Approach to a child with a heart murmur". Indian J Pediatr. 71 (1): 63–6. PMID 14979389.
- ↑ Sissman NJ (1996). "Cardinal clinical signs in the differentiation of heart murmurs in children". Arch Pediatr Adolesc Med. 150 (7): 771. PMID 8673213.
- ↑ Frommelt MA (2004). "Differential diagnosis and approach to a heart murmur in term infants". Pediatr Clin North Am. 51 (4): 1023–32, x. doi:10.1016/j.pcl.2004.03.003. PMID 15275986.
- ↑ Maron BJ, Douglas PS, Graham TP, Nishimura RA, Thompson PD (2005). "Task Force 1: preparticipation screening and diagnosis of cardiovascular disease in athletes". J Am Coll Cardiol. 45 (8): 1322–6. doi:10.1016/j.jacc.2005.02.007. PMID 15837281.
- ↑ 13.0 13.1 13.2 Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D; et al. (2007). "Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation". Circulation. 115 (12): 1643–455. doi:10.1161/CIRCULATIONAHA.107.181423. PMID 17353433.