Subacute Infective Endocarditis in Children: Auscultation Characteristics and Diagnostic Approach
Subacute infective endocarditis (SIE) in children presents unique diagnostic challenges, particularly in its early stages. One of the key clinical signs observed during physical examination is abnormal heart sounds detected through auscultation. The most common auscultatory finding is a systolic click at the apex of the heart, often accompanied by a murmur that may vary in intensity and timing.
Understanding the Auscultation Findings
The systolic click, typically heard during mid-systole, is associated with the movement of abnormal or vegetated heart valves—most commonly the mitral valve. This sound may be subtle and requires careful listening with a high-quality stethoscope. In some cases, a pansystolic murmur may also be present, especially if there is significant valve regurgitation.
Limitations of Auscultation Alone
While auscultation plays a role in initial suspicion, it is not sufficient for a definitive diagnosis of subacute infective endocarditis in children. Many children may present with nonspecific symptoms such as low-grade fever, fatigue, or poor appetite, which can mask the underlying cardiac pathology. Therefore, auscultatory findings should always be interpreted in the context of clinical presentation and other diagnostic tools.
Recommended Diagnostic Workup
If a systolic click or any abnormal heart sound is detected during auscultation, further investigation is warranted. The next steps typically include:
- Echocardiography: This imaging modality is crucial for visualizing valve abnormalities, detecting vegetations, and assessing cardiac function.
- Blood cultures: Obtaining multiple blood cultures is essential for identifying the causative organism and guiding appropriate antimicrobial therapy.
- Inflammatory markers: Laboratory tests such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can support the presence of systemic inflammation.
Conclusion
Early detection of subacute infective endocarditis in children relies on a high index of suspicion, especially when subtle auscultatory findings are present. While heart murmurs and systolic clicks can be important clues, they must be correlated with clinical symptoms and confirmed through advanced diagnostic methods. Prompt referral for echocardiography and laboratory testing is critical in managing this potentially life-threatening condition.