The diagnostic importance of murmurs audible on the back in children with heart disease
Murmurs heard over the back in children with heart disease are usually thought to be caused by pulmonary stenosis and coarctation of the aorta. In this prospective study 59.6% of 104 children with various congenital and acquired heart defects were found to have an audible murmur over the back. An audible murmur over the back of a child with a ventricular septal defect was indicative of either a very small ventricular septal defect or an accompanying underlying cardiac lesion. In children with ventricular septal defect and/or mitral incompetence, auscultation over the back contributed towards making a more accurate clinical and/or anatomical diagnosis. A child with mitral incompetence and an audible murmur over the back will have a grade 2 or more echocardiographic evaluated valve lesion. It is concluded that the presence of a murmur over the back rarely contributes to the final diagnosis but may be indicative of the severity of the underlying lesion.