Echocardiography or auscultation? How to evaluate systolic murmurs.

OBJECTIVE To compare cardiac physical examination with echocardiography for evaluating systolic murmurs.

QUALITY OF EVIDENCE Three databases were searched for studies comparing echocardiography and auscultation as to sensitivity and diagnostic accuracy: MEDLINE (Ovid Online), EMBASE, and Current Contexts. The quality of reported data is lowered by subjective interpretation of results of both cardiac physical examination and echocardiography, especially Doppler colour flow imaging.

MAIN MESSAGE In adults, functional systolic murmurs can usually be distinguished from organic murmurs. Pathologic murmurs frequently have one or more associated clinical abnormalities. If a clinician determines a murmur is benign, results of echocardiography are very likely to be normal, especially in young and middle-aged adults. According to current guidelines, echocardiography should not be ordered for "innocent" systolic murmurs in patients who are asymptomatic and have otherwise normal findings on examination. If patients with functional systolic murmurs could be identified and not routinely referred for echocardiography, great cost savings could be realized.

CONCLUSION Echocardiography is not required for all patients with systolic murmurs and should not replace cardiac physical examination.