Cardiologic evaluation of children with suspected heart disease: experience of a public outpatient clinic in Brazil

ABSTRACT

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 per cent of the pediatric population. This is the most common cause of referral to the pediatric cardiologist. Objective: To report an 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. Partipants 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 per cent), percordial pain (9 per cent), suspicion of arrhythmia (9 per cent) and breathlessness (5 per cent). Of the total number, 695 cases (26 per cent) 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 1) a high incidence of normality was found murmur (83 per cent), pain (98 per cent), arrhythmia (97 per cent) and breathless (94 per cent); 2) heart disease was unlikely, based on other referral reasons; 3) 14 per cent of the children were considered abnormal and 1 per cent 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 pediatricans.