Do ‘pathologic’ cardiac murmurs in adolescents determine structural coronary heart illness? An analysis of 15,141 energetic adolescents for situations that put them susceptible 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.
https://bjsm.bmj.com/content material/56/2/88
Take-Dwelling Message
Classifying cardiac murmurs as “pathological” or “physiological” was not useful in detecting structural coronary heart illness.
Background
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 chance of sudden cardiac dying (e.g., hypertrophic cardiomyopathy).
Research Objective
Austin and colleagues accomplished a retrospective evaluation of 15,141 adolescents (12-19 years outdated) to find out if the presence of a physiological or pathological cardiac murmur associated to structural coronary heart illness, which can improve the chance of sudden cardiac dying.
Strategies
The researchers reviewed information from adolescents who accomplished a neighborhood coronary heart display screen at Seattle space excessive faculties. 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 and not using a 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 based mostly on cardiac auscultations: murmur or management. Cardiac murmurs have been then labeled as both physiological (decreased or no change with Valsalva, or delicate/smooth) 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 based mostly on echocardiogram findings.
Outcomes
General, 905 (17%) adolescents had cardiac murmurs, together with 743 (82%) with physiologic murmurs and 162 (18%) with pathologic murmurs. Amongst adolescents and not using a cardiac murmur, 1.4% had structural coronary heart illness versus 2.4% of these with a physiological murmur and 4.3% with pathological murmurs.
Viewpoints
General, the information from this research means that cardiac auscultations alone usually are not adequate to display screen for structural coronary heart illness throughout a devoted cardiac screening. Moreover, latest efforts to determine a cardiac murmur as physiological or pathological is probably not helpful in detecting structural coronary heart illness (e.g., hypertrophic cardiomyopathy).
Scientific Implications
A generally employed screening technique (cardiac auscultations) could also be inadequate in detecting construction coronary heart illness. The information additionally recommend that efforts to evaluate the seriousness of the cardiac murmur as both pathologic or physiologic usually are not useful. The authors advocated that electrocardiograms ought to be included in cardiac screenings to assist determine people with structural coronary heart illness.
Questions for Dialogue
Do you at present have a possibility for adolescents to endure ECG evaluation? In that case, what standards are used?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
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