title: The not so innocent heart murmur: a 5-year experience.
abstract: BACKGROUND
  Auckland City Hospital (ACH) established a Heart Murmur Clinic (HMC) with the aim of providing prompt assessment of patients with asymptomatic systolic murmurs. This may lead to early intervention and improved outcomes if significant structural heart disease is detected and reassurance if no significant findings are found. Similar clinics for children have proven beneficial; the benefit of a HMC in an adult population has been difficult to determine.
  
  
  OBJECTIVE
  To review the clinical demographics and echocardiographic information of patients presenting to our HMC, to assess what proportion of significance structural heart disease had and determine the common structural abnormalities in this population.
  
  
  METHODS
  This is a retrospective review of patients aged ≥15 years presenting to our HMC between March 2010 and December 2015 with an asymptomatic systolic murmur. Patients with previous cardiac surgery or known congenital or valvular heart disease were excluded.
  
  
  RESULTS
  A total of 1221 patients was reviewed over the 5-year period; 980 underwent echocardiography. Significant cardiac disease was detected in 156 patients, with 23 patients requiring surgical intervention over the 5-year period. Significant aortic stenosis (n = 43) and mitral regurgitation (n = 48) were the most common pathologies. Patients > 65 years were more likely to have structural heart disease (16% vs 11%, P < 0.05).
  
  
  CONCLUSIONS
  Establishing a HMC has allowed the screening of a large number of patients who would otherwise have low priority for assessment. We have identified a large proportion with significant structural disease, which has allowed for early surgical intervention when appropriate and may potentially result in improved patient outcomes.
authors.affiliation: Department of Cardiology, Auckland Hospital, Auckland, New Zealand.
authors.forename: Shaw-Hua
authors.initials: SH
authors.lastname: Kueh
authors.affiliation: Department of Cardiology, Auckland Hospital, Auckland, New Zealand.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pasley
authors.affiliation: Department of Cardiology, Auckland Hospital, Auckland, New Zealand.
authors.forename: Miriam
authors.initials: M
authors.lastname: Wheeler
authors.affiliation: Department of Cardiology, Dunedin Hospital, Dunedin, New Zealand.
authors.forename: James
authors.initials: J
authors.lastname: Pemberton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D004452:Echocardiography; D005260:Female; D006337:Heart Murmurs / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology*; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies
keywords: echocardiography; heart murmur clinic