title: [Heart murmurs in asymptomatic children: When should you refer?].
abstract: Heart murmurs are common in children and adolescents. Although most are innocent, an isolated heart murmur in asymptomatic children may be the sole finding indicating serious heart disease. Historical elements of familial heart disease, cardiovascular symptoms and a well-conducted medical examination can identify children with an increased risk of heart disease. The distinction between an innocent heart murmur and a pathologic heart murmur is not always easy for primary care physicians because most of them have little experience with auscultation searching for congenital heart malformation. Echocardiography provides a definitive diagnosis of heart disease but is not required in case of innocent murmur. Inappropriate pediatric cardiologist and echocardiographic referral leads to useless and expensive examinations, resulting in a work overload for pediatric cardiologists. The objective of this review is to provide the keys to differentiate innocent and pathologic murmurs, and to help physicians decide on the optimal diagnostic strategy.
authors.affiliation: Service de médecine pédiatrique, hôpital Clocheville, CHU de Tours, université François-Rabelais, 49, boulevard Béranger, 37044 Tours cedex, France. Electronic address: chantepie@med.univ-tours.fr.
authors.forename: A
authors.initials: A
authors.lastname: Chantepie
authors.affiliation: Service de médecine pédiatrique, hôpital Clocheville, CHU de Tours, université François-Rabelais, 49, boulevard Béranger, 37044 Tours cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Soulé
authors.affiliation: Service de médecine pédiatrique, hôpital Clocheville, CHU de Tours, université François-Rabelais, 49, boulevard Béranger, 37044 Tours cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Poinsot
authors.affiliation: Service de médecine pédiatrique, hôpital Clocheville, CHU de Tours, université François-Rabelais, 49, boulevard Béranger, 37044 Tours cedex, France.
authors.forename: M C
authors.initials: MC
authors.lastname: Vaillant
authors.affiliation: Service de médecine pédiatrique, hôpital Clocheville, CHU de Tours, université François-Rabelais, 49, boulevard Béranger, 37044 Tours cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Lefort
mesh_terms: D058070:Asymptomatic Diseases; D002648:Child; D002983:Clinical Competence; D004452:Echocardiography; D006326:Heart Auscultation; D006337:Heart Murmurs / Q000175:diagnosis*; D006801:Humans; D012017:Referral and Consultation