THE VIBRATORY INNOCENT HEART MURMUR IN SCHOOLCHILDREN - DIFFERENCE INAUSCULTATORY FINDINGS BETWEEN SCHOOL MEDICAL OFFICERS AND A PEDIATRICCARDIOLOGIST

In 810 schoolchildren heart auscultation was performed by both a schoo l medical officer (SMO) and a pediatric cardiologist (PC). The prevale nce for a grade 1, 2, or 3 vibratory innocent heart murmur (VIHM), a g rade 2 or 3 VIHM, and a grade 3 VIHM heard by the PC was 41%, 13%, and 1%, respectively. The SMO noted such murmurs in 26%, 9%, and 1%, resp ectively. In 30% of the cases in which the PC had noted a grade 2 or 3 VIHM, the SMO agreed; in 30% of such cases the SMO did not hear any h eart murmur. If the PC heard a grade 2 or 3 VIHM phonocardiography was performed in a case-control study in which the controls did not have a heart murmur (94 pairs). In four children with a grade 2 or 3 VIHM n o heart murmur could be registered and in three other children the mur mur did not have the typical diamond shape. In contrast, in three chil dren without a heart murmur at school a VIHM was seen on the phonocard iogram. In 26 children with a phonocardiographically proven grade 2 or 3 VIHM the SMO did not hear any heart murmur. One child with a grade 3 VIHM (both by the PC and SMO) had a minor subvalvular aortic stenosi s. There is quite a difference in auscultatory detection of a venous h um: 9% (PC) and 2% (SMO). The prevalence of the pulmonary ejection mur mur is identical at 4%. The carotid bruit is heard in 4% (PC) and 2% ( SMO). Pathologic murmurs were heard in 12 children by the PC, agreed b y the SMO in two cases. Eight of the 12 pathologic murmurs were confir med by further cardiologic examination and one was decided to be an in nocent pulmonary ejection murmur. The auscultatory findings of 4 SMOs, who examined > 100 children each, differ remarkably when compared sep arately to the results of the PC. Variation in intensity of the heart murmurs and difference in auscultatory skills explain the great differ ence in auscultatory findings between the PC and the SMO. Specialized training of SMO to recognize (pathological) heart murmurs is advocated .