Summary
In 810 schoolchildren heart auscultation was performed by both a school medical officer (SMO) and a pediatric cardiologist (PC). The prevalence for a grade 1, 2, or 3 vibratory innocent heart murmur (VIHM), a grade 2 or 3 VIHM, and a grade 3 VIHM heard by the PC was 41%, 13%, and 1%, respectively. The SMO noted such murmurs in 26%, 9%, and 1%, respectively. In 30% of the cases in which the PC had noted a grade 2 or 3 VIHM, the SMO agreed; in 30% of such cases the SMO did not hear any heart murmur. If the PC heard a grade 2 or 3 VIHM phonocardiography was performed in a case-control study in which the controls did not have a heart murmur (94 pairs). In four children with a grade 2 or 3 VIHM no heart murmur could be registered and in three other children the murmur did not have the typical diamond shape. In contrast, in three children without a heart murmur at school a VIHM was seen on the phonocardiogram. In 26 children with a phonocardiographically proven grade 2 or 3 VIHM the SMO did not hear any heart murmur. One child with a grade 3 VIHM (both by the PC and SMO) had a minor subvalvular aortic stenosis. There is quite a difference in auscultatory detection of a venous hum: 9% (PC) and 2% (SMO). The prevalence of the pulmonary ejection murmur is identical at 4%. The carotid bruit is heard in 4% (PC) and 2% (SMO). Pathologic murmurs were heard in 12 children by the PC, agreed by the SMO in two cases. Eight of the 12 pathologic murmurs were confirmed by further cardiologic examination and one was decided to be an innocent pulmonary ejection murmur. The auscultatory findings of 4 SMOs, who examined >100 children each, differ remarkably when compared separately to the results of the PC. Variation in intensity of the heart murmurs and difference in auscultatory skills explain the great difference in ausculatory findings between the PC and the SMO. Specialized training of SMO to recognize (pathological) heart murmurs is advocated.
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References
Coleman EN, Doig W (1970) Diagnostic problems with innocent hear murmurs in children.Lancet 2:228–232
Danford DA, McNamara DG (1990) Innocent murmurs and heart sounds In: Garson A, Bricker JT, McNamara DG (eds)The science and practive of pediatric cardiology 1990. Lea and Febiger, Philadelphia, p 1920
De Monchy C (1963) Funktionele hartgeruisen bij kinderen. Thesis. Stenfert and Kroese, Leiden, p 39
De Monchy C, Van der Hoeven GMA, Beneken JEW (1973) Studies on innocent praecordial vibratory murmurs in children. III: follow-up study of children with an innocent praecordial vibratory murmur.Br Heart J 35:685–690
Epstein N (1948) The heart in normal infants and children.J Pediatr 32:39–45
Fogel DH (1960) THe innocent systolic murmur in children: a clinical study of its incidence and characteristics.Am Heart J 59:844–855
Freeman AR, Levine SA (1993) The clinical significance of the systolic murmur: a study of 1000 consecutive noncardiac cases.Ann Int Med 6:1371–1385
Harris TN, Friedman S (1952) Phonocardiographic differentiation of vibratory (functional) murmurs from those of valvular insufficiency: further observations and application to the diagnosis of rheumatic heart disease.Am Heart J 43:707–712
Hochsinger C (1913) Ueber bedeutunglose geräusche in der präcordialgegend von kindern und jugendlichen.Arch Kinderh 60:377–396
Klewer SE, Donnerstein RL, Goldberg SJ (1991) Still's-like innocent murmur can be produced by increase aortic velocity to a threshold value.Am J Cardiol 68:810–812
Leatham A, Segal B, Shafter H (1963) Auscultatory and phonocardiographic findings in healthy children with systolic murmurs.Br Heart J 25:451–459
Lincoln EM (1928) The hearts of normal children.Am J Dis Child 35:398–410
Lockart ML (1938) Stethograph.Am Heart J 16:72–78
Luisada AA, Haring OM, Aravanis C, Cardi L, Jona E, Zilli AB (1958) Murmurs in children: a clinical and graphic study in 500 children of school age.Ann Int Med 48:597–615
Marienfeld CJ, Telles N, Silvera J, Nordsieck M (1962) A 20-year follow-up study of “innocent” mjrmurs.Pediatrics 30:42–48
McLaren MJ, Lachman AS, Pocock WA, Barlow JB (1980) Innocent heart murmurs and third heart sounds in black schoolchildren.Br Heart J 43:67–73
Paulin S, Mannheimer E (1957) The physiologycal heart murmur in children.Acta Paediatr 46:438–448
Rappaport MB, Sprague HB (1941) Physiologic and physical laws that govern auscultation and their clinical application.Am Heart J 21:257–318
Sampson JJ, Hahman PT, Halverson WL, Shearer MC (1945) Incidence of heart disease and rheumatic fever in school children in three climatically different California communities.Am Heart J 29:178–204
Still GF (1915)Common disorders and diseases of childhood, 3rd ed. Frowde, Hodder and Stoughton, London, pp 495–496
Stuckey D, Dowd B, Walsh H (1957) Cardiac murmurs in schoolchildren.Med J Austr I:36–38
Van Oort A, Van Dam I, Heringa A, Alsters J, Hopman J, Daniëls O (1986) The vibratory innocent heart murmur studied by echo-Doppler.Acta Paediatr Scand 329(Suppl):103–107
Wells B (1957) The graphic configuration of innocent systolic murmurs.Br Heart J 19:129–134
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Van Oort, A., Le Blanc-Botden, M., De Boo, T. et al. The vibratory innocent heart murmur in schoolchildren: Difference in auscultatory findings between school medical officers and a pediatric cardiologist. Pediatr Cardiol 15, 282–287 (1994). https://doi.org/10.1007/BF00798121
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DOI: https://doi.org/10.1007/BF00798121