Reappraisal of the approach to the child with heart murmurs: is echocardiography mandatory?

Int J Cardiol. 1988 Apr;19(1):107-13. doi: 10.1016/0167-5273(88)90196-9.


The performance of cross-sectional echocardiography on every child with a heart murmur poses a heavy load and economic burden on pediatric cardiology services. We prospectively studied 100 consecutive patients newly referred to our clinic for evaluation of a heart murmur. After a thorough clinical assessment and review of the electrocardiogram and chest radiograms, 50 patients were diagnosed as having "innocent murmurs". Cross-sectional echocardiography confirmed the initial diagnosis in 48 patients (96%). Two patients had bicuspid aortic valve. Among the patients with echocardiographically proved innocent murmur, left ventricular anomalous bands were demonstrated in 15 patients (31%), right ventricular anomalous bands in 5 patients (10%) and increased left ventricular shortening fractions (greater than or equal to 0.5) in 10 patients (21%). Among the remaining 50 patients, the initial diagnosis was "suspected heart disease" in 10 patients, and "pathological murmurs" in 40 patients. Cross-sectional echocardiography was most useful in these patients providing the diagnosis in 80% (eight) of the former group and 95% (38) of the later group. Echocardiography need not be routinely performed in children initially diagnosed, by a pediatric cardiologist, as having an "innocent murmur".

MeSH terms

  • Adolescent
  • Aortic Valve Stenosis / diagnosis
  • Child
  • Child, Preschool
  • Ductus Arteriosus, Patent / diagnosis
  • Echocardiography*
  • Female
  • Heart Auscultation / classification*
  • Heart Murmurs / classification*
  • Heart Septal Defects, Atrial / diagnosis
  • Heart Septal Defects, Ventricular / diagnosis
  • Humans
  • Infant
  • Male
  • Predictive Value of Tests
  • Prospective Studies
  • Pulmonary Valve Stenosis / diagnosis
  • Tetralogy of Fallot / diagnosis