The morbidity of cardiac nondisease revisited. Is there lingering concern associated with an innocent murmur?
P. C. Young
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.
BACKGROUND--The phenomenon of cardiac nondisease was first reported in 1967
to call attention to the fact that some children were being restricted from
their normal activities because their parents believed that they had a
heart problem when, in fact, the child's heart was perfectly normal. This
influential article and others have suggested that there may be significant
morbidity in children who have been found to have innocent cardiac murmurs.
METHODS--Parents of 71 schoolchildren were interviewed 1 to 5 years after
their child had been examined by a pediatric cardiologist. Parents were
asked about the presence of a family history of heart disease, their recall
of the diagnosis and recommendations made by the cardiologist, and their
level of satisfaction with the visit to the cardiologist. Parents were
extensively questioned for evidence of restriction of the child's
activities and for the presence of a belief that their child's murmur was
something to still be concerned about. RESULTS--None of the parents
reported restricting their child's activity, but 12 (17%) were still
concerned about the murmur. A statistically significant relationship
between parents reporting being less than "very satisfied" with the visit
to the cardiologist and the presence of concern was found (P = .0006 by chi
2, Yates' correction). No other associations were noted. CONCLUSION--The
association with a lower degree of satisfaction suggests that communication
issues are relevant to the presence of lingering parental concern. Because
the parents of a child with an innocent murmur may consider him or her to
be "vulnerable," primary care physicians should follow up with parents of
children referred to pediatric cardiologists for evaluation of a murmur so
that any potential misunderstandings can be clarified.
