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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Heart murmur screening

Introduction

Overview

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

  • 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

References

  1. ↑ Bansal M, Jain H (2005). “Cardiac murmur in neonates”. Indian Pediatr. 42 (4): 397–8. PMID 15876611.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Frank JE, Jacobe KM (2011). “Evaluation and management of heart murmurs in children”. Am Fam Physician. 84 (7): 793–800. PMID 22010618.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ Poddar B, Basu S (2004). “Approach to a child with a heart murmur”. Indian J Pediatr. 71 (1): 63–6. PMID 14979389.
  10. ↑ Sissman NJ (1996). “Cardinal clinical signs in the differentiation of heart murmurs in children”. Arch Pediatr Adolesc Med. 150 (7): 771. PMID 8673213.
  11. ↑ 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.
  12. ↑ 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. ↑ 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.

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]