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

PEDIATRICS ◽  
1993 ◽  
Vol 92 (2) ◽  
pp. 304-304
Author(s):  
WARREN H. TOEWS
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Recent Article ◽  
Congenital Heart ◽  
Cost Assessment ◽  
Heart Murmur ◽  
Pediatric Cardiologist ◽  
Heart Murmurs ◽  
Echocardiographic Evaluation

To the Editor.— I read with the recent article by Danford et al regarding "cost assessment of heart murmur evaluation." I agree completely with the authors that echocardiographic evaluation of heart murmurs is more costly than referral to a pediatric cardiologist. In this study, the authors utilized echocardiograms ordered at their own institution, presumably performed by technicians trained and experienced in the evaluation of children for congenital heart disease, and interpreted by pediatric cardiologists trained and experienced in interpretation of pediatric echocardiograms.

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

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.

Prevalence and diagnostic accuracy of heart disease in children with asymptomatic murmurs

2015 ◽  
Vol 26 (3) ◽  
pp. 446-450 ◽  
Author(s):  
Adziri H. Sackey
Keyword(s):  
Heart Disease ◽  
Diagnostic Accuracy ◽  
Clinical Examination ◽  
Clinical Assessment ◽  
Congenital Heart ◽  
Heart Murmur ◽  
Paediatric Cardiologist ◽  
Heart Murmurs ◽  
Cardiology Clinic ◽  
Heart Lesions

AbstractThis study was performed to determine the prevalence of CHD among children referred with asymptomatic murmurs and to determine the diagnostic accuracy of the assessment of asymptomatic heart murmurs by general paediatricians. We reviewed the records of children who had been referred by general paediatricians to a cardiology clinic for further evaluation of a heart murmur. The referring paediatricians’ clinical assessment of the murmur was compared with the cardiologist’s echocardiographic diagnosis. A total of 150 children were referred by paediatricians to a paediatric cardiologist for further assessment of a heart murmur. Out of 150 children, 72 had a paediatrician’s diagnosis of innocent murmur; of these 72 patients, two (3%) had heart disease on echocardiography. In all, after echocardiography, a range of congenital heart lesions was found in 28 (19%) of the 150 children. CHD is not rare among children with asymptomatic heart murmurs. In this series of children with asymptomatic murmurs, 19% had heart lesions on echocardiography. Most, but not all, of the children with heart lesions were identified on clinical examination by general paediatricians.

Transoesophageal echocardiographic evaluation of atrial morphology in children with congenital heart disease

1992 ◽  
Vol 13 (2) ◽  
pp. 223-231 ◽  
Author(s):  
B. TUCCILLO ◽  
O. STÜMPER ◽  
J. HESS ◽  
R. J. VAN SUIJLEN ◽  
E. BOS ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Echocardiographic Evaluation

Outcome of children referred with heart murmurs referred from general practice to a paediatrician with expertise in cardiology

2014 ◽  
Vol 25 (1) ◽  
pp. 123-127 ◽  
Author(s):  
Abha Khushu ◽  
Anthony W. Kelsall ◽  
Juliet A. Usher-Smith
Keyword(s):  
Primary Care ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Family History ◽  
General Practitioners ◽  
Congenital Heart ◽  
Hospital Records ◽  
Heart Murmurs ◽  
History Of ◽  
Referral Practice

AbstractBackgroundHeart murmurs are common in children. The majority are detected incidentally, and congenital heart disease is rare. There are no published United Kingdom guidelines for management of children with murmurs in primary care. Common practice is to refer all children for specialist assessment.AimTo review outcomes of children with heart murmurs who were referred by general practitioners to a clinic conducted by a paediatrician with expertise in cardiology.Design and settingA retrospective review of children referred by general practitioners to a paediatrician with expertise in cardiology.MethodsHospital records of all children under 17 years of age who attended the clinic during 2011 were reviewed. We excluded children previously seen by any cardiology service.ResultsThere were 313 new primary care referrals, with complete records available for 310 children. Of them, 186 (60%) were referred with a murmur: 154 for an asymptomatic murmur alone, and 32 for a murmur plus additional symptoms or family history of congenital heart disease. All underwent echocardiography. Of the patients, 38 (20%) had congenital heart disease. Younger children were more likely to have congenital heart disease. There was no difference between rates of congenital heart disease in children with or without symptoms or a family history.ConclusionThe finding that a large proportion of children referred by general practitioners with asymptomatic heart murmurs have congenital heart disease supports current referral practice on clinical grounds.

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