Abordagem da criança com sopro cardíaco. Importância diagnóstica dos exames complementares não-invasivos / Approaching to the Child With Heart Murmur. Diagnostic Relevance of Noninvasive Laboratory Tests

RESUMO

PURPOSE--To determine the benefits of noninvasive tests in the characterization of heart disease in children referred due to heart murmur. METHODS--Two hundred and thirty three consecutive children were fully examined with the aid of the electrocardiograma (ECG), chest X-ray and echocardiogram (ECHO). The patients were divided in 2 groups according to the initial diagnosis of innocent murmur (n = 23) and pathological murmur (n = 210). A comparison was made between the initial and final diagnosis after the noninvasive tests. Statistical analysis was employed through the qui-square test. RESULTS--The initial diagnosis did not change after ECG. The chest X-ray induced the diagnosis of idiopathic dilatation of the main pulmonary artery in one case and of cardiomyopathy in 8 cases, confirmed in only one. After ECHO, the initial diagnosis of innocent murmur was maintained in 70 of the cases, while 30 had some form of heart disease. In 80 of the pathologic murmur group, the diagnosis did not change after ECHO, while 20 were considered as having an innocent murmur. In the 2 groups together, the concordance index between initial and final diagnosis after ECHO reached 90. Statistically, a non-significant difference was found between the 2 groups. CONCLUSION--Careful clinical examination is mandatory in the initial evaluation of children with heart murmur. ECG and chest X-ray does not change the initial clinical diagnosis. After ECHO, the diagnosis changing was low (10), as long as clinical mistakes are eliminated. The initial diagnosis of innocent murmur excludes the necessity of noninvasive tests with a small possibility of error. EKG, chest X-ray and ECHO should be reserved to cases with obvious or persistent suspicious heart disease after clinical examination.