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AAP Grand Rounds 4:9-10 (2000) Screening for Heart Disease: We Need To Do BetterSource:Steinberger J, Moller JH, Berry JM, et al.Echocardiographic diagnosis of heart disease in apparently healthy adolescents. Pediatrics. 2000;105:815818.
To evaluate the accuracy of history and physical examination in detecting heart disease, the authors compared the results of a complete physical examination against a reference standard of a complete two-dimensional and Doppler echocardiography for 357 apparently healthy adolescents participating in a longitudinal study of insulin resistance at the University of Minnesota. Although all participants were examined by a board-certified pediatrician and were found free from evidence of heart disease, 13 abnormal echocardiograms were recorded. The most common unappreciated cardiac conditions in these children were minor left-sided cardiac valve abnormalities such as mitral valve pro-lapse and bicuspid aortic valve. Seven subjects, however, had more serious conditions, including atrial septal defect (2), patent ductus arteriosus (1), coronary artery fistula (1), pulmonary artery stenosis (1), pulmonary hypertension (1), and dilated cardiomyopathy (1). Five of these 7, in the judgment of the authors, should have cardiac catheterization and/or surgery.
The pediatric cardiologist who interpreted the echocardiograms also examined the 13 abnormal subjects and concluded that,
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