Cardiologic evaluation of children with suspected heart disease
experience of a public outpatient clinic in Brazil
Keywords:
Heart disease, Child, Incidence, EpidemiologyAbstract
CONTEXT: During initial evaluation of children on an outpatient basis, the index of suspected heart disease may be high, particularly if we consider that innocent murmur occurs in about 50% of the pediatric population. This is the most common cause of referral to the pediatric cardiologist. OBJECTIVE: To report on the experience of a public outpatient clinic in the southeastern region of Brazil. DESIGN: Retrospective analysis of all patients submitted to cardiologic evaluation within a 39 month period. SETTING: public pediatric cardiology outpatient clinic. PARTICIPANTS: 2675 consecutive children aged £15 years referred from the local and regional basic health units due to suspected heart disease. MAIN MEASUREMENTS: Reason for referral, diagnostic investigation, final diagnostis based on the reason for referral, therapeutic procedures. RESULTS: The main reasons for referral were: murmur (70%), precordial pain (9%), suspicion of arrhythmia (9%) and breathlessness (5%). Of the total number, 695 cases (26%) did not complete the investigation and were not included in the analysis. A final diagnosis was obtained based on the reason for referral and the main conclusions were: l) a high incidence of normality was found: murmur (83%), pain (98%), arrhythmia (97%) and breathless (94%); 2) heart disease was unlikely, based on other referral reasons; 3) 14% of the children were considered abnormal and 1% needed therapeutical procedures. CONCLUSIONS: The establishment of a pediatric cardiology outpatient clinic within the public health service in the region seems to be justifiable, due to the high current demand. The low global incidence of heart disease, with a high prevalence of children with innocent murmur, discloses the need for a specific training program in cardiology for pediatricians.
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References
Friedman S, Robie WA, Harris TN. Occurrence of innocent adventitious cardiac sounds in childhood. Pediatrics 1949;4:782-9.
Gibson S. Clinical significance of heart murmurs in children. Med Clin North Am 1946;30:35-6.
Thayer WS. Reflections on the interpretation of systolic cardiac murmurs. Am J Med Sci 1925;169:313-21s.
Sideris EB, Sideris SE, Ehly RL. Occlusion of patent ductus arteriosus in piglets by a double-disc self-adjustable device. Abstract. J Am Coll Cardiol 1990;15:240A.
Geva T, Hegesh J, Frand M. Reappraisal of the approach to the child with heart murmur: is echocardiography mandatory? Int J Cardiol 1988;19:107-13.
Roberts WC. Anomalous left ventricular band: an unemphasized cause of precordial musical murmurs. Am J Cardiol 1969;23:735-8.
Schwartz Ml, Goldberg SJ, Wilson N, et al. Relation of Stills murmur, small aortic diameters and high aortic velocity. Am J Cardiol 1986;57:1344-8.
Caceres CA, Perry LW. The innocent murmur: a problem in clinical practice. Boston: Little Brown and Co; 1967.
Newburger JM, Rosenthal A, Williams RG, Fellows K, Miettinen OS. Noninvasive tests in the initial evaluation of heart murmurs in children. N Engl J Med 1983;308:61-4.
Tavel ME. The systolic murmur: innocent or guilty? Am J Cardiol 1977;39:757-9.
Amaral FTV, Granzotti JA, Nunes MA. Abordagem da criança com sopro cardíaco: importância diagnóstica dos exames complementares năo invasivos. Arq Bras Cardiol 1995; 64:195-9.
Smythe JF, Teixeira OHP, Vlad P, Demers PP, Feldman W. Initial evaluation of heart murmurs: are laboratory tests necessary? Pediatrics 1990;86:497-500.
Brenner JI, Ringel RE, Berman MA. Cardiologic perspectives of chest pain in childhood: a referral problem? to whom? Ped Clin North Am; 1984:1241-58.
Epstein SE, Gerber LH, Borer JS. Chest wall syndrome: a common cause of unexplained cardiac pain. J Am Med Assoc 1979;241:2793-7.
McKenna W, Deanfield J, Faruqui A, et al. Prognosis in hypertrophic cardiomyopathy: role of age, clinical and hemodynamic features. Am J Cardiol 1981;47:532-8.
Bisset GS, Schwartz DC, Meyer RA, et al. Clinical spectrum and long term follow-up of isolated mitral valve prolapse in 119 children. Circulation 1980;2:423-9.
Okoroma EO, Perry LW, Scott LP. Acute bacterial pericarditis in children: report of 25 cases. Am Heart J 1975;90:709-13.
Melish ME. Kawasaki syndrome (the mucocutaneous lymph node syndrome). Pediatr Ann 1982;11:255-68.
Bertoletti JC. Disritmias cardíacas. In: Cardiologia Pediátrica. Macruz R, Snitcowski R. Săo Paulo: Sarvier;1983:601.
Andrews R, Colloby P, Hubner JB. Pulmonary artery dissection in a patient with idiopathic dilatation of the pulmonary artery: a rare cause of sudden cardiac death. Br Heart J 1993;69:268-9.
Gidding SS, Rosenthal A. The interface between primary care and Pediatric Cardiology. Ped Clin North Am 1984;31:1367-88.
Amaral FTV, Granzotti JA, Nunes MA. Sopro cardíaco na criança: experięncia de um ambulatório especializado. Rev Paul Pediatr 1995;13:39-41.
