Heart Murmur and Physical Examination in Athletes with a Focus on Congenital Heart Disease

Background: Undiagnosed congenital heart disease in the prenatal stage can occur in approximately 5 to 15 out of 1000 live births; more than a quarter of these will have critical congenital heart disease (CCHD). Late postnatal diagnosis is associated with a worse prognosis during childhood, and there is evidence that a standardized measurement of oxygen saturation in the newborn by cutaneous oximetry is an optimal method for the detection of CCHD. We conducted a systematic review of the literature and meta-analysis comparing the operational characteristics of oximetry and physical examination for the detection of CCHD. Methods: A systematic review of the literature was conducted on the following databases including published studies between 2002 and 2017, with no language restrictions: Pubmed, Science Direct, Ovid, Scopus and EBSCO, with the following keywords: oximetry screening, critical congenital heart disease, newborn OR oximetry screening heart defects, congenital, specificity, sensitivity, physical examination. Results: A total of 419 articles were found, from which 69 were selected based on their titles and abstracts. After quality assessment, five articles were chosen for extraction of data according to inclusion criteria; data were analyzed on a sample of 404,735 newborns in the five included studies. The following values were found, corresponding to the operational characteristics of oximetry in combination with the physical examination: sensitivity: 0.92 (CI 95%, 0.87-0.95), specificity: 0.98 (CI 95%, 0.89-1.00), for physical examination alone sensitivity: 0.53 (CI 95%, 0.28-0.78) and specificity: 0.99 (CI 95%, 0.97-1.00). Conclusions: Evidence found in different articles suggests that pulse oximetry in addition to neonatal physical examination presents optimal operative characteristics that make it an adequate screening test for detection of CCHD in newborns, above all this is essential in low and middle-income settings where technology medical support is not entirely available.

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Physical Examination and Electrocardiography in Patients with Pulmonary Arterial Hypertension Due to Congenital Heart Disease: Initial Clinical Assessment

Pulmonary Hypertension in Adult Congenital Heart Disease - Congenital Heart Disease in Adolescents and Adults ◽

10.1007/978-3-319-46028-4_9 ◽

2017 ◽

pp. 121-148

Author(s):

Margherita Ministeri ◽

Natali Chung ◽

Konstantinos Dimopoulos

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulmonary Arterial Hypertension ◽

Physical Examination ◽

Arterial Hypertension ◽

Clinical Assessment ◽

Congenital Heart ◽

Pulmonary Arterial

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The Neonate with Congenital Heart Disease, by Richard D. Rowe, M.D., Ch.B., F.R.C.P. (Edin.), and Au Mehrizi, M.B. Philadelphia: W.B. Saunders Company, 1968, 445 pp., $12.50

PEDIATRICS ◽

10.1542/peds.43.1.154a ◽

1969 ◽

Vol 43 (1) ◽

pp. 154-154

Author(s):

James W. Dushane

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Physical Examination ◽

Congenital Heart ◽

Pediatric Cardiology ◽

Monograph Series ◽

The Subject

The Neonate with Congenital Heart Disease should prove to be a successful member of the monograph series on major problems in clinical pediatrics. The book is highly recommended for the physician interested in neonatobogy, pediatrics, or pediatric cardiology. The early chapters cover those aspects of the anatomy, physiology, physical examination, electrocardiography, radiology, incidence, and etiology of congenital heart disease that pertain to the newborn. The text, while brief, successfully summarizes the subject in a concise and lucid manner, using a strikingly extensive and current bibliography.

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Diagnostic accuracy of heart murmur in newborns with suspected congenital heart disease

Journal of Cardiovascular Medicine ◽

10.2459/jcm.0b013e3283649953 ◽

2015 ◽

Vol 16 (8) ◽

pp. 556-561 ◽

Cited By ~ 3

Author(s):

Natale D. Brunetti ◽

Simona Rosania ◽

Carmine D’Antuono ◽

Annamaria D’Antuono ◽

Luisa De Gennaro ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Diagnostic Accuracy ◽

Congenital Heart ◽

Heart Murmur

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Comparison of accuracy of diagnosis of congenital heart disease by history and physical examination versus echocardiography

The American Journal of Cardiology ◽

10.1016/s0002-9149(02)02341-x ◽

2002 ◽

Vol 89 (11) ◽

pp. 1329-1331 ◽

Cited By ~ 11

Author(s):

Scott E. Klewer ◽

Ricardo A. Samson ◽

Richard L. Donnerstein ◽

Daniela Lax ◽

Rolando Zamora ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Physical Examination ◽

Congenital Heart

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Diagnosis of Neonatal Congenital Heart Disease: A Combination of Heart Murmur, SpO2 Abnormality, Tachypnea, and Extracardiac Malformations

Journal of Nanomaterials ◽

10.1155/2021/9962950 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Kai Chen ◽

Jiao Wang ◽

Huihui Zhou ◽

Xiang Huang

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Heart Murmur ◽

Heart Murmurs ◽

Group A ◽

Postnatal Outcome ◽

Group B ◽

Group D ◽

Youden’S Index

Congenital heart disease (CHD) is one of the commonest congenital malformations that are mostly asymptomatic at birth, which challenges the diagnosis of neonatal CHD. An early accurate prenatal diagnosis will give parents a choice, as well as the opportunity to plan the delivery and improve the postnatal outcome. The purpose of the study is to evaluate the value of heart murmurs, SpO2 abnormalities, tachypnea, and extracardiac malformations in screening neonatal CHD. All 4500 newborns in the obstetrics department of our hospital from January 2019 to January 2020 are selected as study subjects. Newborns were grouped according with the presence of heart murmurs, tachypnea, transdermal SpO 2 < 95 % , and extracardiac malformations alone or in combination (≥3). Patients with murmur, tachypnea, and abnormal SpO2 were assigned into group A, those with murmur, tachypnea, and extracardiac malformations into group B, those with murmurs, SpO2, and extracardiac malformations into group C, those with SpO2, tachypnea, and extracardiac malformations into group D, and those with all four into group E. The color echocardiography identified 65 children with CHD (1.4%) among the included 4,500 newborns. When murmur, tachypnea, abnormal SpO2, and extracardiac malformation were independently used to diagnose CHD, the sensitivity ranged from 30.68% to 51.26%, with specificity ranging from 47.36% to 82.65% and Youden’s index (YI) ranging from 0.13 to 0.36. When murmur, tachypnea, abnormal SpO2, extracardiac malformation were together used to diagnose CHD, 91.23% sensitivity, 95.26 specificity, and 0.91 YI were observed. In conclusion, a combination of four indicators, murmur, tachypnea, abnormal SpO2, and extracardiac malformation yielded good performance in diagnosing neonatal CHD.

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Heart Murmurs. If You Allow for Mistakes Costs Are Even Higher!

PEDIATRICS ◽

10.1542/peds.92.2.304b ◽

1993 ◽

Vol 92 (2) ◽

pp. 304-304

Author(s):

WARREN H. TOEWS

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Cardiac Examination, Valvular Heart Disease, and Congenital Heart Disease

10.1093/med/9780199755691.003.0042 ◽

2012 ◽

Author(s):

Kyle W. Llarich

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Physical Examination ◽

Cardiac Imaging ◽

Congenital Heart ◽

Imaging Techniques ◽

Venous Pressure ◽

Cost Effective ◽

Cardiac Imaging Techniques ◽

Positron Emission

Despite tremendous technologic advances in medical testing and imaging, physicians must be able to assess patients accurately at the bedside; this assessment allows appropriate, cost-effective, and efficient ordering of tests. Part I of this chapter outlines the salient features of a thorough physical examination, cardiac imaging techniques, and valvular and congenital heart disease. A thorough physical examination includes assessment of jugular venous pressure, arterial pulses, apical impulses, additional cardiac palpitations, and appropriate imaging techniques. Cardiac imaging techniques include contrast angiography, echocardiography, radionuclide imaging, magnetic resonance imaging, electron beam computed tomography and positron emission tomography. Different types of valvular and congenital heart disease are examined.

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Congenital heart disease: issues with screening at the newborn physical examination

British Journal of Midwifery ◽

10.12968/bjom.2019.27.11.682 ◽

2019 ◽

Vol 27 (11) ◽

pp. 682-687

Author(s):

Helen Seignior

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Physical Examination ◽

Congenital Heart ◽

Research Evidence ◽

Screening Tool ◽

Screening Tools ◽

Anatomy And Physiology ◽

Heart Murmurs ◽

Developed World

Congenital heart disease (CHD) is a significant cause of infant death in the developed world. For this reason, screening for CHD forms part of the newborn physical examination (NPE) that occurs within 72 hours of birth. This article reviews the challenges faced by the examiner in the detection of CHD in the newborn. This includes relevant anatomy and physiology of the newborn circulation and the presentation of heart murmurs. The usefulness of additional screening tools is also discussed. Four-limb blood pressure (BP) is found to be unhelpful as a screening tool, whereas the use of pulse oximetry is supported by research evidence.

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