Anxiety level of parents of children aged 0-18 referred to tertiary pediatric cardiology center due to cardiac murmur and comparison of the effect of pediatric cardiologist examination and transthoracic echocardiography result on parental anxiety

INTRODUCTION: Cardiac murmur is a common physical examination finding in our country in healthy children without any complaints. Murmurs develop as a result of the increased flow rate and tissue vibrations caused by regions of different widths existing between the heart chambers and the vessels exiting from there, or between two vessels. Incidental murmurs are heard in 30% of pediatric routine examinations, and studies have shown that 75-80% of these murmurs are innocent murmurs and are not associated with any cardiac anomaly. However, since most parents associate the detection of a cardiac murmur in their children with cardiac pathologies and think that surgery, medication use, or physical activity limitation will be necessary, a cardiac murmur in childhood is a situation that causes serious anxiety for parents. In this study, the anxiety level of parents of pediatric patients referred to a tertiary pediatric cardiology center due to cardiac murmur and the effect of pediatric cardiologist examination and transthoracic echocardiography on parental anxiety were investigated. MATERIALS AND METHODS: In our study, 109 patients aged 0-18 years who were referred to Celal Bayar University Hafsa Sultan Hospital Pediatric Cardiology Outpatient Clinic due to cardiac murmur between January 2023 and November 2023 were included. The criteria for inclusion in the study were that the patients had no previous known cardiac pathology, no echocardiography had been performed, and the parents had no known psychiatric diagnosis. The first survey was administered to a parent of the patients who agreed to participate in the study, before the cardiologist examined the patient and informed the family about the murmur detected in the child. The second survey was administered after the pediatric cardiologist examined and informed, and the third survey was administered to the patients after transthoracic echocardiography was performed. According to the results of the first survey, the basal anxiety level of the parents and the factors affecting it were investigated, and according to the results of the second and third surveys, their anxiety levels were compared and evaluated respectively. SPSS Statistics (Statistical Package for the Social Sciences) 29.0.2.0 was used in the statistical data analysis of the study. RESULTS: 109 patients and their parents were included in the study. The ages of the children included in the study ranged from 1 month to 17 years. The average age of the patients was found to be 42.5±48.07 months. It was observed that 32 (29.4%) of the participating parents were male and 77 (70.6%) were female. The ages of the parents of the children included in the study ranged between 16 and 55 years, the median age was 31 years and the average age was 31.08±6.58 years. When the family history of the admitted patients was examined, it was seen that 49 of them (45%) had no cardiac history in their family. It was determined that 22 (24%) of the families had heart disease requiring follow-up from the cardiology unit, 19 (17.4%) had heart disease requiring surgery, and 11 (10.1%) had sudden death due to cardiac reasons. Only 6 (5.5%) of the patients had a family history of cardiac murmur. Of the 109 patients who were referred due to an innocent murmur, 43 (39.4%) had a grade 1/6 murmur, 57 (52.3%) had a grade 2/6 murmur, and 9 (8.3%) had a grade 3/6 murmur. . It was observed that 86 (78.9%) of the patients had no complaints at the time of admission, and 23 (21.1%) had complaints. When the echocardiography results of 109 patients were examined, normal echocardiography was observed in 27 (24.7%), PFO was observed in 18 (16.5%), false tendon in the right ventricle was observed in 17 (15.5%) patients. TR of various degrees in 20 patients (18.3%), ASD secundum in 7 (6.4%) patients, VSD in 5 patients (4.5%), PDA in 4 patients (3.6%), PS in 2 patients (1.8%) and MVP in 1 patient (0.9%) were also seen. According to the results of the first surveys, the parents' basal depression score was 16.67±2.22 and their basal anxiety score was 19.48±2.39, and both basal anxiety and basal depression scores were seen to be high. While no significant relationship was found between the parental age, parental gender, education level, income status, number of siblings of the patients, and complaints of the patients and the anxiety levels of the parents investigated in the demographic characteristics, a negative correlation was found between the parental age and the basal anxiety level. While there was no statistically significant change in the parents' basal depression scores according to the HADS scale, a significant decrease was detected in their basal anxiety scores both after the pediatric cardiology examination and after echocardiography. CONCLUSION: As seen in our study, detecting a cardiac murmur in pediatric patients causes significant anxiety in parents. This anxiety decreased significantly after the examination of the pediatric cardiologist and after echocardiography. According to the findings of the study, normal or physiological echocardiography findings were observed in 73.1% of the patients referred to the pediatric cardiology outpatient clinic due to murmur, and no surgical operation, medication use or physical activity restriction was recommended for any patient. When all the findings are considered together, it is concluded that not every murmur needs to be evaluated with echocardiography after the patient's murmur can be distinguished as innocent or pathological.