Nadas' Criteria for Clinical Diagnosis of Heart Disease
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Overview and Utility
Clinical assessment tool determining presence of heart disease.
Diagnostic threshold: ONE major criterion OR TWO minor criteria.
Limitation: Reduced utility in newborns due to subtle clinical signs.
Diagnostic Categories
Major Criteria
Systolic murmur grade III or more: Indicates significant abnormality. Pansystolic murmurs always abnormal regardless of intensity.
Diastolic murmur: Almost always indicates organic heart disease.
Central cyanosis: Suggests right-to-left shunt or inadequate pulmonary oxygenation.
Congestive cardiac failure: Strongly indicates heart disease. Exclude extracardiac causes (anemia, hypoglycemia) in neonates and infants.
Minor Criteria
Systolic murmur grade I or II: Soft murmurs do not exclude heart disease.
Abnormal second heart sound: Highly subjective but extremely useful bedside tool for classifying heart disease.
Abnormal electrocardiogram (ECG): Determines axis, hypertrophy, or conduction issues.
Abnormal chest X-ray: True cardiomegaly on inspiratory film suggests heart disease. Caution: Normal thymus mimics cardiomegaly in children under two years.
Abnormal blood pressure: Aids in identifying specific hemodynamic anomalies.
