Alvares S, Ferreira M, Ferreira H, Mota C R
Unidades de Cardiologia Pediátrica, Hospital de Crianças Maria Pia, Porto.
Rev Port Cardiol. 1997 Jul-Aug;16(7-8):621-4, 588; discussion 625.
Heart murmur, most of them innocent, are the most common reason for referrals to a pediatric cardiologist.
The objective of this study was to analyse the utility of the electrocardiogram (ECG) and echocardiography in the initial assessment of heart murmurs in an asymptomatic pediatric population.
For each of 170 consecutive children who were seen for first time evaluation of a heart murmur, the clinical diagnosis was registered and the patients were classified as having innocent murmur (IM), pathologic murmur (PM), or possible pathologic murmur (PPM). The results of ECG and echocardiogram two-dimensional/Doppler were registered and changes in diagnosis were recorded and compared with the original impressions.
After ECG no diagnosis was changed. After two-dimensional/Doppler echocardiogram the clinical diagnosis of innocent murmur in 118 children was changed to pathologic in one (one trivial pulmonary stenosis); pathologic murmurs in 43 children was changed to innocent in two; and possible pathologic in nine children was changed to innocent in six and possible pathologic in three. The clinical examinations had a sensitivity of 97.6%, specificity of 93.6%, positive predictive value of 95.3%, and negative predictive value of 99.1%.
Clinical assessment by a Pediatric Cardiologist is sufficient to distinguish pathologic from innocent heart murmurs. Echocardiography, although diagnostic when heart disease is suspected, is unnecessary in a pediatric patient with clinically diagnosed innocent murmur.
心脏杂音大多为生理性的，是转诊至儿科心脏病专家处的最常见原因。
本研究的目的是分析心电图（ECG）和超声心动图在无症状儿科人群心脏杂音初始评估中的效用。
对连续170例首次因心脏杂音接受评估的儿童，记录临床诊断，并将患者分为生理性杂音（IM）、病理性杂音（PM）或可能病理性杂音（PPM）。记录心电图和二维/多普勒超声心动图的结果，记录诊断变化并与原始印象进行比较。
心电图检查后诊断无变化。二维/多普勒超声心动图检查后，118例生理性杂音患儿中有1例（轻度肺动脉狭窄）临床诊断变为病理性；43例病理性杂音患儿中有2例变为生理性；9例可能病理性杂音患儿中有6例变为生理性，3例仍为可能病理性。临床检查的敏感性为97.6%，特异性为93.6%，阳性预测值为95.3%，阴性预测值为99.1%。
儿科心脏病专家的临床评估足以区分病理性和生理性心脏杂音。超声心动图虽然在怀疑有心脏病时具有诊断价值，但对于临床诊断为生理性杂音的儿科患者来说并非必需。
