Heart murmur disappearance on standing can rule out pathology

(HealthDay)—For children aged 2 and older, disappearance of a heart murmur on standing is a reliable tool for excluding pathologic murmur, according to a study published in the November/December issue of the Annals of Family Medicine.

Bruno Lefort, M.D., from the University Hospital Centre of Tours in France, and colleagues conducted a prospective study involving 194 children aged 2 to 18 years who were referred to pediatric cardiologists for heart murmur evaluation. Characteristics of heart murmur were recorded while the children were supine and standing, and echocardiogram was performed.

The researchers found that 15 percent of the children had a pathologic heart murmur as indicated by an abnormal echocardiogram. Only two of the 100 children who had a murmur that was present while they were supine but disappeared completely when they stood up had a pathologic murmur, and only one of them needed further assessment. Complete disappearance of the heart murmur on standing excluded pathologic murmur with positive predictive value of 98 percent and with specificity and sensitivity of 93 and 60 percent, respectively.

"Disappearance of a heart murmur on standing is a reliable clinical tool for ruling out pathologic heart murmurs in children aged 2 years and older," the authors write. "This basic clinical assessment would avoid many unnecessary referrals to cardiologists."

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