TY  - CHAP
M1  - Book, Section
TI  - Chapter 483. Neonate and Infant with Cardiovascular Disease
A1  - Teitel, David F.
A2  - Rudolph, Colin D.
A2  - Rudolph, Abraham M.
A2  - Lister, George E.
A2  - First, Lewis R.
A2  - Gershon, Anne A.
PY  - 2011
T2  - Rudolph's Pediatrics, 22e
AB  - Although  there  are  over  7000  different  congenital  cardiac  defects,1  there  are  only  a  very  few  ways  that  a  newborn  or  infant  presents  with  cardiac  disease.  Symptomatic  heart  disease  occurs  in  about  40%  of  congenital  lesions,  so  that  many  infants  present  without  symptoms.  For  this  reason,  perhaps,  many  clinicians  consider  the  presence  of  a  murmur  as  the  most  definitive  evidence  of  heart  disease.  Unfortunately,  this  is  the  source  of  a  very  large  number  of  unnecessary  referrals  to  the  pediatric  cardiologist—the  vast  majority  of  murmurs  occur  in  patients  with  normal  hearts,  and  most  innocent  murmurs  are  misdiagnosed.2  Up  to  50%  of  normal  children  present  with  an  innocent  murmur  at  some  time,  whereas  only  about  50%  of  newborns  with  symptomatic  heart  disease  have  murmurs  on  clinical  presentation.  Even  assuming  that  all  of  the  children  without  symptoms  who  have  congenital  heart  disease  have  murmurs,  this  would  make  the  presence  of  a  murmur  to  be  about  2%  specific  and  80%  sensitive  in  the  diagnosis  of  heart  disease.  There  is  no  other  sign  in  medicine  that  has  such  poor  specificity  and  sensitivity  yet  is  used  with  such  certainty.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesspediatrics.mhmedical.com/content.aspx?aid=7047102
ER  -