July 1996

Cardinal Clinical Signs in the Differentiation of Heart Murmurs in Children

Author Affiliations

Professor of Pediatrics Division of Pediatric Cardiology University of Medicine and Dentistry of New Jersey One Robert Wood Johnson Place—Cn 19 New Brunswick, NJ 08903-0019

Arch Pediatr Adolesc Med. 1996;150(7):771. doi:10.1001/archpedi.1996.02170320117027

The article by McCrindle et al1 in the February 1996 issue of the Archives is a valuable contribution to efforts to make the referrals of infants and children to pediatric cardiologists for evaluation of murmurs more rational and efficient. I was disappointed that the authors made only passing reference to the key issue of how to improve our education of non-cardiologists in auscultation of the heart, so they may become more confident in recognizing innocent murmurs.

I was interested, also, to observe that the authors did not discuss 1 clinical feature from the history that had a P value of less than. 001, namely, the "age at encounter." Clearly, if a murmur is heard for the first time after the age of 1 year, the statistical chances of that murmur's arising from a cardiac lesion are low. Experienced clinicians have recognized this since the early days of pediatric cardiology; emphasizing

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