Titre
Should functional cardiac murmurs be diagnosed by auscultation or by Doppler echocardiography?
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Bloch, A.
Auteure/Auteur
Crittin, J.
Auteure/Auteur
Jaussi, A.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
0160-9289
Statut éditorial
Publié
Date de publication
2001-12
Volume
24
Numéro
12
Première page
767
Dernière page/numéro d’article
9
Notes
Comparative Study
Journal Article --- Old month value: Dec
Journal Article --- Old month value: Dec
Résumé
BACKGROUND: For many years, cardiac auscultation has been the only available method for distinguishing between functional and organic murmurs; however, a more reliable differential diagnosis can now be achieved with Doppler echocardiography. The question remains as to whether a Doppler echocardiogram needs to be routinely recorded in the presence of a heart murmur or whether the auscultatory diagnosis of a functional murmur is sufficient. HYPOTHESIS: This prospective study attempts to answer this important question at a time when medical costs have to be curbed. METHODS: The three cardiologists involved in this study saw 516 new patients in their private practice over a 10-month period; of these, 321 (63.6%) underwent Doppler echocardiography. All patients underwent careful auscultation prior to echocardiography. At the end of their examinations, the cardiologists noted whether they considered the murmur to be of functional or organic origin. Minimal mitral or aortic regurgitations of short duration and low velocity occurring on non-thickened valves were considered functional. RESULTS: The results for cardiac auscultation and Doppler echocardiography were considered to be concordant, that is, both techniques diagnosed either a functional or organic murmur in 250 of 321 patients (77.9%). The results for cardiac auscultation and Doppler echocardiography showed a major discordance in just six cases (1.9%). All were mitral regurgitations of moderate severity. CONCLUSION: The prevalence of cardiac murmurs in the general population is very high. As echocardiography currently represents a significant proportion of cardiac medical expenditure, it would be wise to limit the use of this technique to essential indications. This study confirms that both cardiac auscultation and Doppler echocardiography possess important limitations. Nevertheless, it also shows that well-trained cardiologists can identify the vast majority of functional murmurs on auscultation. Better training of nonspecialist physicians in cardiac auscultation may help in containing medical expenses.
Sujets
PID Serval
serval:BIB_A91FEE3100BE
PMID
Open Access
Oui
Date de création
2008-01-28T10:53:59.455Z
Date de création dans IRIS
2025-05-21T00:18:00Z