title: Evaluation of Diagnostic Methods in the Differentiation of Heart Murmurs in Children.
abstract: BACKGROUND
  The most common clinical sign in pediatric cardiology is a heart murmur (organic and inorganic). Organic are sign of heart disease, while inorganic (basically divided into accidental and functional) murmurs occur on anatomically healthy heart.
  
  
  OBJECTIVE
  To determine the justification of the application of the methods of cardiac treatment.
  
  
  METHODS
  Study included 116 children aged from 1 to 15 years, who were referred due to cardiac treatment to Pediatric Clinic, of Sarajevo University Clinical Center.
  
  
  RESULTS
  The first group consisted of children with innocent heart murmur, 97 (53 males). The second group consisted of patients with organic murmur, 19 (13 males). The average age of the first group was 7.69 (1.01-15.01) years old, and of the second group 3.15 (1.01- 8.06) years old, and there is a significant difference between these two groups (p <0.001). Medical history questions about potentially harmful habits of mother in pregnancy, found significant differences in the frequency of the existence of habits between the first and second groups of subjects (14.44% vs. 85.1%, p = 0.013). The values of the pulse of patients showed statistically significant difference (p = 0.012). The most common place of the murmurs' appearance is the second left intercostal space. In the first group, the most common were vibratory (32.3%) and ejection (31.9%) and in the second the most common were holosystolic (73.7%) murmur. Analyzing the R/S ratio of V1, a significant difference among the two groups was found (mean 0.78 vs. the values for 1.45, p = 0.003). There is a significance in terms of developed hypertrophy of the heart cavities (BVH) between the two groups. The most common accidental murmur was classic vibratory Still's murmurs (55.43%) and the most common congenital heart defects was ASD (36.8%).
  
  
  CONCLUSIONS
  A heart murmur itself, should not be the purpose of auscultation. One of the tasks of pediatricians, pediatric cardiologists in particular would be to improve auscultation, as a sovereign method of heart murmurs assessment. Heart murmur assessment should be adapted to recognize whether heart murmur is innocent, or there is suspected or probable congenital heart defect.
authors.affiliation: Pediatric Clinic Sarajevo, Clinical center of Sarajevo University, Sarajevo, Bosnia and Herzegovina.
authors.forename: Zijo
authors.initials: Z
authors.lastname: Begic
authors.affiliation: Pediatric Clinic Sarajevo, Clinical center of Sarajevo University, Sarajevo, Bosnia and Herzegovina.
authors.forename: Senka Mesihovic
authors.initials: SM
authors.lastname: Dinarevic
authors.affiliation: Clinic for Emergency medicine, Clinical center of Sarajevo University, Bosnia and Herzegovina.
authors.forename: Senad
authors.initials: S
authors.lastname: Pesto
authors.affiliation: Clinic for Emergency medicine, Clinical center of Sarajevo University, Bosnia and Herzegovina.
authors.forename: Edin
authors.initials: E
authors.lastname: Begic
authors.affiliation: Medical and Biological Engineering Society of BiH, Sarajevo, Bosnia and Herzegovina.
authors.forename: Amra
authors.initials: A
authors.lastname: Dobraca
authors.affiliation: Department of Family medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: Izet
authors.initials: I
authors.lastname: Masic
keywords: cardiac treatment of heart murmurs; heart murmurs; pediatric cardiology