{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T06:18:08Z","timestamp":1783577888670,"version":"3.55.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiac murmurs are common in childhood, yet their detection often triggers significant parental anxiety. This study aimed to measure anxiety levels in parents of infants and young children under 24 months of age referred to pediatric cardiology due to heart murmurs, using the State-Trait Anxiety Inventory (STAI-S) before and after examination, and to investigate the impact of expert assessment and echocardiography (ECHO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective study included parents of 241 asymptomatic children (under 24 months) referred for initial cardiac evaluation due to a murmur. Parental anxiety was measured using the STAI-S before and after a comprehensive clinical evaluation, including ECHO. Participants were categorized based on ECHO findings: normal, benign physiological findings, and minor structural anomalies requiring follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean pre-consultation STAI-S was 51.17\u2009\u00b1\u20096.34, which significantly decreased to 45.89\u2009\u00b1\u20097.84 following evaluation [\n                      <jats:italic>t<\/jats:italic>\n                      (240)\u2009=\u200910.44,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001, Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.67]. While anxiety levels dropped significantly across all ECHO groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), no statistical difference was found between groups regarding anxiety reduction (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.108). Exploratory item analysis revealed that consultation primarily reduced negative emotions rather than immediately increasing positive emotional states. Regression analysis showed that a family history of heart disease was the only significant independent predictor increasing pre-examination anxiety (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20092.129;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Specialized pediatric cardiology consultation and echocardiographic evaluation substantially reduce parental anxiety, independent of socioeconomic characteristics or specific cardiac findings in this cohort. Clinicians should prioritize early, tailored communication for high-risk families with a family history of heart disease to effectively manage the psychological burden of a heart murmur referral.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1901573","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:36:12Z","timestamp":1783575372000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Parental anxiety levels before and after pediatric cardiology evaluation with echocardiography in asymptomatic children with heart murmurs: a prospective study"],"prefix":"10.3389","volume":"14","author":[{"given":"Hikmet","family":"K\u0131ztan\u0131r","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Recep Tayyip Erdogan University Faculty of Medicine","place":["Rize, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beyza","family":"Elmal\u0131","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Recep Tayyip Erdogan University","place":["Rize, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"49","DOI":"10.16919\/bozoktip.1017560","article-title":"\u00c7ocuk kardiyoloji uzman\u0131na kardiyak \u00fcf\u00fcr\u00fcm nedeniyle g\u00f6nderilen \u00e7ocuklar\u0131n ebeveynlerindeki anksiyete d\u00fczeyinin de\u011ferlendirilmesi evaluation of the anxiety level in the parents whose children were sent to A pediatric cardiologist due to A cardiac murmur","volume":"12","author":"\u00c7etin","year":"2022","journal-title":"Bozok T\u0131p Dergisi"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1177\/0009922816632199","article-title":"Referrals to pediatric cardiology outpatients: continued evidence of increasing workload","volume":"55","author":"Morrison","year":"2016","journal-title":"Clin Pediatr (Phila)"},{"key":"B3","first-page":"250","article-title":"Heart murmurs in children: evaluation and management","volume":"105","author":"Ford","year":"2022","journal-title":"Am Fam Physician"},{"key":"B4","doi-asserted-by":"publisher","first-page":"556","DOI":"10.2459\/JCM.0b013e3283649953","article-title":"Diagnostic accuracy of heart murmur in newborns with suspected congenital heart disease","volume":"16","author":"Brunetti","year":"2015","journal-title":"J Cardiovasc Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1067\/mpd.2002.124379","article-title":"Parental anxiety associated with referral of a child to a pediatric cardiologist for evaluation of a Still\u2019s murmur","volume":"140","author":"Geggel","year":"2002","journal-title":"J Pediatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1016\/j.hlc.2019.02.003","article-title":"Does echocardiography have a role in the cardiologist\u2019s diagnosis of innocent murmurs in childhood?","volume":"29","author":"Ip","year":"2020","journal-title":"Heart Lung Circ"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1111\/ped.14664","article-title":"Parental anxiety and misperceptions in children with innocent murmurs","volume":"63","author":"Akrivopoulou","year":"2021","journal-title":"Pediatr Int"},{"key":"B8","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1186\/s12887-015-0507-4","article-title":"Parental anxiety related to referral of childhood heart murmur; 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