The diagnostic value of auscultations, requirement of electrocardiography and telecardiography for evaluation of innocent murmurs in childhood

The purpose of this study was to evaluate differences in pre-diagnosis in innocentheart murmurs between a paediatric research assistant and a paediatric cardiologyspecialist, the role of echocardiography in patients with murmur and the contribution todiagnosis of telecardiography and ECG. Three hundred and eight cases presenting withheart murmur at the Karadeniz Technical University Faculty of Medicine PaediatricsDepartment Cardiology Section between June 2010 and July 2011 were analyzedretrospectively. Cases? ages ranged between 1 day and 17 years (median 36 months).Cardiac pathology was determined following echocardiography in 31 (13.7%) of226 cases thought by a paediatric research assistant to have innocent murmur.Hemodynamically insignificant small atrial septal defect was present in 13 (5.7%) of these,small muscular ventricular septal defect in five, minimal mitral insufficiency in three,atrioventricular septal defect in two, mild narrowing in the pulmonary artery walls in two,minimal aortic insufficiency in two, atrial septal defect in two, perimembranous ventricularseptal defect in one and third-degree mitral insufficiency in one. Cardiac pathology wasobserved in 23 (9.1%) of the 252 patients thought to have innocent murmur by thepaediatric cardiology specialist. Small secundum atrial septal defect was seen in 10 ofthese cases, small muscular ventricular septal defect in six, minimal mitral insufficiency inthree, atrioventricular septal defect in two and minimal aortic insufficiency in two.Cardiological pathology was determined following echocardiography in 49 (15.9%) of the308 cases. The majority of these pathologies were hemodynamically unimportant, slightmodifications. Two cases of atrioventricular septal defect with Down syndrome and onecase diagnosed with third-degree mitral insufficiency accompanied by dilatedcardiomyopathy, thought to be innocent murmur by both researchers, were significantpathologies that emerged during the course of the research. The paediatric researchassistant achieved 75% sensitivity, 36% specificity, 86% positive prediction and 21%negative prediction in the diagnosis of innocent heart murmur. The paediatric cardiologyspecialist achieved sensitivity of 85%, specificity of 53%, positive prediction of 90% andnegative prediction of 31%. There was a significant difference between the paediatricresearch assistant and paediatric cardiology specialist in terms of diagnosis of innocentheart murmur and distinguishing pathological murmurs. Telecardiography and ECGcontributed nothing to the diagnosis of innocent murmurs.Examination findings may be insufficient for diagnosis in the neonatal period. Wethink that all murmurs in this period should be evaluated with echocardiography and thatECG and telecardiography need only be employed in selected cases.Key Words: Innocent murmurs, Echocardiograpy, Congenital heart disease.