Approach to the child with murmur Invited Editor

Abstract

Heart murmur is a common finding in children Fortunately most of these murmurs are innocent murmurs Innocent murmurs can be detected in 70 85 of healthy children In contrast the incidence of congenital heart disease is 0 8 and acquired heart disease is rare in children Therefore distinguishing innocent from pathologic murmur is a frequent and an important task for the physician Heart murmurs of children can usually be diagnosed through a careful history and physical examination If an abnormality is detected; electrocardiogram telecardiogram and echocardigram should be ordered to diagnose the cause of the murmur In this report the features of murmurs innocent murmurs how to evalute a murmur use of laboratory studies in diagnosis and management of a child with a murmur were reviewed Turk Arch Ped 2009; 44: 48 52 Key words: Children congenital heart disease echocardiography murmur

Keywords

• -

Üfürümlü çocuğa yaklaşım Çağrılı Editör

Öz

Kalp üfürümü çocuklarda sık saptanan bir bulgudur Ancak bu üfürümlerin çoğu masum üfürümlerdir Masum üfürümler sağlıklı çocukların 70 85’inde saptanabilirler Aksine doğuştan kalp hastalıklarının sıklığı 0 8’dir ve edinsel kalp hastalıkları çocuklarda nadirdir Bundan dolayı bir doktor için masum bir üfürümü sıra dışı bir üfürümden ayırt etmek sık karşılaşılan ve önemli bir konudur Çocuklardaki kalp üfürümlerine genellikle ayrıntılı bir öykü ve fizik muayene ile tanı koyulabilir Eğer bir sıra dışılık saptanırsa üfürümün nedenini saptamak için elektrokardiyografi telekardiyogram ve ekokardiyogram istenmelidir Bu yazıda üfürümlerin özellikleri masum üfürümler üfürümlerin değerlendirilmesi tanıda laboratuvar tetkiklerinin kullanımı ve üfürümlü bir çocuğa yaklaşımdan bahsedildi Türk Ped Arş 2009; 44: 48 52 Anahtar kelimeler: Çocuklar doğuştan kalp hastalığı ekokardiyografi üfürüm

Anahtar Kelimeler

• Çocuklar, doğuştan kalp hastalığı, ekokardiyografi, üfürüm

References

1. Advani N, Menahem S, Wilkinson JL. The diagnosis of inno- cent murmurs in childhood. Cardiol Young 2000; 10: 340-2.
2. Pelech A. Evaluation of the pediatric patient with a cardiac murmur. Pediatr Clin North Am 1999; 46: 167-87.
3. Allen HD, Phillips JR, Chan DP. History and physical exami- nation. In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF (eds). Heart Disease in Infants, Children and Adolescents. Phila- delphia: Williams&Wilkins, 2008: 58-66.
4. Duff DF, McNamara DG. History and physical examination of the cardiovascular system. In: Garson A, Bricker JT, Fisher DJ, Neish SR (eds). The Science and Practice of Pediatric Cardiology. Baltimore: Williams&Wilkins, 1998: 693-713.
5. Koo S, Yung TC, Lun KS, Chau AK, Cheung YF. Cardiovascu- lar symptoms and signs in evaluating cardiac murmurs in chil- dren. Pediatr Int 2008; 50: 145-9.
6. Silverman ME, Wooley CF. Levine and the history of the gra- ding systolic murmurs. Am J Cardiol 2008; 102: 1107-10.
7. Swenson JM, Fischer DR, Miller SA, Boyle GJ, Ettedgui JA, Beerman LB. Are chest radiographs and electrocardiograms still valuable in evaluating new pediatric patients with heart murmur or chest pain? Int J Cardiol 2006; 111: 1-5.
8. Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. JACC 2006; 48: 8-13

9. Shub C. Echocardiography or auscultation? How to evaluate systolic murmurs. Can Fam Physician 2003; 49: 163-7.
10. Bewick D. Office approach to heart murmurs. Can Fam Physi- cian 1991; 37: 665-8.
11. McNamara DG. Value and limitations of auscultation in the management of congenital heart disease. Pediatr Clin North Am 1990; 37: 93-113.
12. Mahnke CB, Nowalk A, Hofkosh D, Zuberbuhler JR, Law YM. Comparison of two educational interventions on pediatric re- sident auscultation skills. Pediatrics 2004; 113: 1331-5.
13. Thompson WR, Hayek CS, Tuchinda C, Telford JK, Lombar- do JS. Automated cardiac auscultation for detection of patho- logic heart murmurs. Pediatr Cardiol 2001; 22: 373-9.
14. Finley JP, Warren AE, Sharratt GP, Amit M. Assessing chil- drens heart sounds at a distance with digital recordings. Pe- diatrics 2006; 118: 2322-5.
15. Mondillo S, Giannotti G, Innelli P, Balo PC, Galderisi M. Hand- held echocardiography: its use and usefulness. Mayo Clin Proc 2005; 80: 1443-8.