Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T04:07:30.088Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcome of children referred with heart murmurs referred from general practice to a paediatrician with expertise in cardiology

Published online by Cambridge University Press:  09 June 2014

Abha Khushu ,
Anthony W. Kelsall  and
Juliet A. Usher-Smith
Abha Khushu
Affiliation:
Murray Edwards College, University of Cambridge, Huntingdon Road, Cambridge, United Kingdom
Anthony W. Kelsall
Affiliation:
NICU, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom
Juliet A. Usher-Smith*
Affiliation:
The Primary Care Unit, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, United Kingdom
*
Correspondence to: J. Usher-Smith, The Primary Care Unit, Strangeways Research Laboratory, University of Cambridge, 2 Worts Causeway, Cambridge CB1 8RN, United Kingdom. Tel: +44 (0) 122 374 8693; Fax: +44 (0) 1223 768412; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Heart murmurs are common in children. The majority are detected incidentally, and congenital heart disease is rare. There are no published United Kingdom guidelines for management of children with murmurs in primary care. Common practice is to refer all children for specialist assessment.

Aim

To review outcomes of children with heart murmurs who were referred by general practitioners to a clinic conducted by a paediatrician with expertise in cardiology.

Design and setting

A retrospective review of children referred by general practitioners to a paediatrician with expertise in cardiology.

Methods

Hospital records of all children under 17 years of age who attended the clinic during 2011 were reviewed. We excluded children previously seen by any cardiology service.

Results

There were 313 new primary care referrals, with complete records available for 310 children. Of them, 186 (60%) were referred with a murmur: 154 for an asymptomatic murmur alone, and 32 for a murmur plus additional symptoms or family history of congenital heart disease. All underwent echocardiography. Of the patients, 38 (20%) had congenital heart disease. Younger children were more likely to have congenital heart disease. There was no difference between rates of congenital heart disease in children with or without symptoms or a family history.

Conclusion

The finding that a large proportion of children referred by general practitioners with asymptomatic heart murmurs have congenital heart disease supports current referral practice on clinical grounds.

Keywords

Paediatricsheart murmurreferralgeneral practice
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 1 , January 2015 , pp. 123 - 127
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Thompson, E, Todd, P, Ni Bhrolchain, C. The epidemiology of general paediatric outpatients referrals: 1988 and 2006. Child Care Health Dev 2011; 39: 44–49.Google Scholar
2. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.Google Scholar
3. Morgan, BC. Incidence, etiology, and classification of congenital heart disease. Pediatr Clin North Am 1978; 25: 721–723.Google Scholar
4. Wren, C, Richmond, S, Donaldson, L. Presentation of congenital heart disease in infancy: implications for routine examination. Arch Dis Child Fetal Neonatal Ed 1999; 80: F49–F53.Google Scholar
5. McCrindle, BW, Shaffer, KM, Kan, JS, Zahka, KG, Rowe, SA, Kidd, L. Cardinal clinical signs in the differentiation of heart murmurs in children. Arch Pediatr Adolesc Med 1996; 150: 169–174.Google Scholar
6. Frank, JE, Jacobe, KM. Evaluation and management of heart murmurs in children. Am Fam Physician 2011; 84: 793–800.Google Scholar
7. Burton, DA, Cabalka, AK. Cardiac evaluation of infants. The first year of life. Pediatr Clin North Am 1994; 41: 991–1015.Google Scholar
8. Danford, DA, Gumbiner, C, Nasir, A. Cost assessment of the evaluation of heart murmurs in children. Pediatrics 1993; 91: 365–368.Google Scholar
9. Sánchez, M, Rubio, I, Vera, J. Variables associated with pathologic heart murmurs in primary care consultations. Aten Primaria 1993; 12: 672–674.Google Scholar
10. Kwiatkowski, D, Wang, Y, Cnota, J. The utility of outpatient echocardiography for evaluation of asymptomatic murmurs in children. Congenit Heart Dis 2012; 7: 283–288.Google Scholar
11. Bansal, M, Jain, H. Cardiac murmur in neonates. Indian Pediatr 2005; 42: 397–398.Google Scholar
12. Rein, AJ, Omokhodion, SI, Nir, A. Significance of a cardiac murmur as the sole clinical sign in the newborn. Clin Pediatr (Phila) 2000; 39: 511–520.Google Scholar
13. Ainsworth, S, Wyllie, JP, Wren, C. Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child Fetal Neonatal Ed 1999; 80: F43–F45.Google Scholar
14. Marek, J, Skovránek, J, Hucín, B, et al. Seven-year experience of noninvasive preoperative diagnostics in children with congenital heart defects: comprehensive analysis of 2,788 consecutive patients. Cardiology 1995; 86: 488–495.Google Scholar
15. Smythe, JF, Teixeira, OH, Vlad, P, Demers, PP, Feldman, W. Initial evaluation of heart murmurs: are laboratory tests necessary? Pediatrics 1990; 86: 497–500.Google Scholar
16. NICE Short Clinical Guidelines Technical Team. Prophylaxis Against Infective Endocarditis: Antimicrobial Prophylaxis Against Infective Endocarditis in Adults and Children Undergoing Interventional Procedures. National Institute for Health and Clinical Excellence, London, 2008.Google Scholar
17. Giuffre, RM, Walker, I, Vaillancourt, S, Gupta, S. Opening Pandora’s box: parental anxiety and the assessment of childhood murmurs. Can J Cardiol 2002; 18: 406–414.Google Scholar
18. Saraçlar, M, Cil, E, Ozkutlu, S. Echocardiography for the diagnosis of congenital cardiac anomalies with multiple lesions. Pediatr Cardiol 1996; 17: 308–313.Google Scholar