Do ‘pathologic’ cardiac murmurs in adolescents determine structural coronary heart illness? An analysis of 15,141 lively adolescents for circumstances that put them vulnerable to sudden cardiac dying.
Austin AV, Owens DS, Prutkin JM, Salerno JC, Ko B, Pelto HF, Rao AL, Siebert DM, Carrol JS, Harmon KG, Drezner JA. Br J Sports activities Med 2022;56:88-94. doi: 10.1136/bjsports-2019-101718. Epub 2021 Jan 15. PMID: 33451997.
Classifying cardiac murmurs as “pathological” or “physiological” was not useful in detecting structural coronary heart illness.
Cardiac screenings are a necessary a part of preparticipation screening. Cardiac auscultations are generally assessed however could fail to precisely determine adolescents with structural coronary heart illness that improve the danger of sudden cardiac dying (e.g., hypertrophic cardiomyopathy).
Austin and colleagues accomplished a retrospective evaluation of 15,141 adolescents (12-19 years previous) to find out if the presence of a physiological or pathological cardiac murmur associated to structural coronary heart illness, which can improve the danger of sudden cardiac dying.
The researchers reviewed information from adolescents who accomplished a group coronary heart display screen at Seattle space excessive colleges. Every screening included a private and household well being questionnaire, bodily evaluation, cardiac auscultations, and electrocardiogram. The authors particularly analyzed information from 5,238 adolescents with no pre-existing coronary heart situation who required a further echocardiogram due to an abnormality on historical past, bodily examination, or electrocardiogram. They stratified adolescents into 2 teams primarily based on cardiac auscultations: murmur or management. Cardiac murmurs had been then categorized as both physiological (decreased or no change with Valsalva, or delicate/gentle) or pathological (harsh, elevated with Valsalva, any diastolic murmur, radiating, click on/gallop/splitting, crescendo–decrescendo, or holosystolic). The authors outlined structural coronary heart illness primarily based on echocardiogram findings.
General, 905 (17%) adolescents had cardiac murmurs, together with 743 (82%) with physiologic murmurs and 162 (18%) with pathologic murmurs. Amongst adolescents with no cardiac murmur, 1.4% had structural coronary heart illness versus 2.4% of these with a physiological murmur and 4.3% with pathological murmurs.
General, the info from this examine means that cardiac auscultations alone should not ample to display screen for structural coronary heart illness throughout a devoted cardiac screening. Moreover, current efforts to determine a cardiac murmur as physiological or pathological is probably not helpful in detecting structural coronary heart illness (e.g., hypertrophic cardiomyopathy).
A generally employed screening methodology (cardiac auscultations) could also be inadequate in detecting construction coronary heart illness. The info additionally recommend that efforts to evaluate the seriousness of the cardiac murmur as both pathologic or physiologic should not useful. The authors advocated that electrocardiograms needs to be included in cardiac screenings to assist determine people with structural coronary heart illness.
Questions for Dialogue
Do you at the moment have a possibility for adolescents to endure ECG evaluation? In that case, what standards are used?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban