Simple Test Can Help Rule Out Pathologic Heart Murmur in Children

The disappearance of heart murmur while standing excluded a pathologic murmur

A study published in the Annals of Family Medicine shows that disappearance of heart murmur while standing reliably rules out pathologic heart murmurs in children.

Although heart murmur in children is usually harmless, in a small number of cases it is symptomatic of cardiac disease.

Using an acoustic-based, non-electronic stethoscope, Bruno Lefort, MD, Children Hospital Gatien de Clocheville, University Hospital Centre of Tours, Tours Cedex, France, and colleagues noted heart sound characteristics of 194 consecutive children referred to paediatric cardiologists for heart murmur, first with patients in the supine position, and then for at least 1 minute in the standing position.

After observational data were collected, an echocardiogram was performed to assess the presence or absence of cardiac anomalies that could explain the murmur.

Of the children refereed to a cardiologist for heart murmur, 85% did not have cardiac disease. Only 30 children (15%) had an abnormal echocardiogram that explained the heart murmur.

Of 100 children (51%) who had heart murmur while supine but not standing, 2 had an organic murmur and only 1 required follow-up.

The disappearance of heart murmur while standing, therefore, excluded a pathologic murmur with a high predictive positive value of 98% and a specificity of 93%, but with a poor sensitivity of 60%.

In an era of highly technical medicine, physical examination should remain the first step in diagnosis, according to the authors. However, "the disappearance of heart murmur in children upon standing is a valuable clinical test to exclude a pathologic cardiac murmur and avoid costly referral to a cardiologist," the authors noted.