OP-069 Clinical and Echocardiographic Evaluation of Silent Carditis in Children with Rheumatic Fever

Abstract

Differential Diagnosis of Innocent Heart Murmurs In Children. Zijo Begic, Edin Begic, Nedim Begic. Pediatric Clinic, CCU Sarajevo, Sarajevo, Bosnia and Herzegovina; Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina. Introduction: Heart murmurs in children are the most common reason for specialist cardiac treatment. Evaluation of heart murmur represents exclusion or existence of congenital anomalies of the heart. Normal anatomical and functional findings of heart must be proven with clinical examination, electrocardiography (ECG), as well as X-ray diagnostics, laboratory diagnostics, less often with echocardiography, and other noninvasive and invasive methods. There are organic, functional, and innocent murmurs. Objectives: The main objective was to show the frequency and significance of innocent heart murmurs in children. Study was made in order to show the wrong trend in modern medicine, the neglect of classical detection methods, primarily auscultation. Material-Methods: The study included 1827 patients who were treated at the Health Centre “Dom zdravlja Breza”, in Breza (primary health care), Bosnia and Herzegovina, from January till 20th December 2014. This study had prospective and analytical character. Results: Heart murmurs were registered in 251 (13,7%) patients, in 203 (80,8%) that was an accidental finding, while 48 (19,2%) had symptoms that could be linked to the cardiovascular disorder. In 63 (25%) patients ECG was done (doctor/ parent request), in 19 complete X-ray of the heart and lungs, and 11 patients underwent additional laboratory tests. Ultrasound evaluation was performed in 50 (19,9%) patients, and on 8 (3,1%) patients abnormal findings have been observed (mainly for monitoring). Two patients had indication for cardiovascular/ interventional procedure (ostium secundum atrial septal defect 10.6 mm and ductus arteriosus persistens 2.8 mm). Conclusion: In everyday practice, clinical diagnosis and differential diagnosis of heart murmurs in children are based mainly on the use of auscultation of the heart. Echocardiography should not be routine, initial method. It is necessary to adjust the treatment of heart murmurs, with assessment of whether it is innocent heart murmur, suspected congenital heart defect or probable congenital heart defect. Given that most of the heart murmurs are innocent, family doctors and paediatricians, should be trained to recognize heart murmurs, so knowledge could rationalize sole use of expensive diagnostic methods.