MURMURS IN CHILDREN: A CLINICAL AND GRAPHIC STUDY IN 500 CHILDREN OF SCHOOL AGE

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Abstract
A clinical and graphic study was made in 500 unselected children between the ages of 4 and 17. Clinical auscultation was made by 3 examiners. Eegs and phonocardlograms were recorded in all cases. Further clinical and graphic studies were made in 87 cases having louder murmurs. Fluoroscopy was done in 40 cases. Hematological studies were made in 38 cases. A medium or loud systolic murmur was found in 23.3% of the cases, with no significant difference between the two sexes. The majority of systolic murmurs were pulmonic, but a fair number were heard at the apex and over the aortic area. No correlation was found between murmurs and economic background, or height and weight. The Q-T interval was not prolonged in children with murmurs. Over 1/2 of the murmurs were "musical". The murmur was "diamond-shaped" in slightly less than 1/2, while it was "in decrescendo" in more than 1/2. A mitral origin was indicated in over 1/2, a pulmonic or aortic origin in the rest. In 6.5% of the cases, significant differences were found between clinical examination and phonocardiographic find-Ing. No change was found in bloods of children with murmurs. Fluoroscopy revealed a dilated and strongly pulsating pulmonary artery in 75% of children with louder murmurs. The systolic murmurs of children had no different clinical or graphic characteristics than "organic" murmurs. The frequency of occurrence of these murmurs was not considered as implying a "physiologic" origin. Autopsy studies of persons of various ages have revealed the great frequency in the cardiac valves of minor damage; lesions were found in 20% of the cases between the ages of 11 and 15, which coincided with 2390 of cases in which medium or loud murmurs were observed in the present series. The murmurs may be caused by a discrete rheumatic process which, in the majority of cases, is not followed by important valvular lesions; or they may be due to non-rheumatic, possibly allergic valvulitis. In either case, it is considered impossible to separate these murmurs from those of valvular lesions which have greater clinical significance.
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