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The Journal of Veterinary Medical... Sep 2023A 1-month-old crossbred calf was referred for examination due to marked systolic heart murmurs and poor growth. The heart murmur was most audible on the right side of...
A 1-month-old crossbred calf was referred for examination due to marked systolic heart murmurs and poor growth. The heart murmur was most audible on the right side of the cranial thorax. Cardiomegaly was evident on chest radiography, and echocardiography demonstrated aortic regurgitation and decreased fractional shortening. Cardiomegaly, aortic root dilation and cardiac displacement were confirmed by computed tomography. At necropsy, the heart was enlarged, and all three aortic valve leaflets were irregularly shaped. In calves with chronic aortic insufficiency, remodeling displacement of the heart and aorta causes changes in the location and timing of heart murmurs. Therefore, aortic insufficiency cannot be ruled out when a systolic heart murmur can be observed in the right chest wall.
Topics: Animals; Cattle; Aortic Valve Insufficiency; Aortic Valve; Heart Murmurs; Echocardiography; Cardiomegaly; Cattle Diseases
PubMed: 37532587
DOI: 10.1292/jvms.23-0139 -
Pediatrics International : Official... Oct 2021Previous studies in children with innocent murmurs have shown that parental concern is common. Our aim was to assess the level of anxiety among parents of children...
BACKGROUND
Previous studies in children with innocent murmurs have shown that parental concern is common. Our aim was to assess the level of anxiety among parents of children referred for cardiology evaluation because of an innocent heart murmur and investigate their perceptions about innocent murmurs.
METHODS
A questionnaire was completed by parents before and after consultation. The questionnaire included a six-item short form of the state scale of the Spielberger State-Trait Anxiety Inventory. After the echocardiogram, a detailed consultation was offered including a thorough explanation that the results were normal, as well as a written report.
RESULTS
A total of 417 questionnaires were completed by parents of 340 children. Almost half of the parents believed that a heart murmur signifies heart disease or may interfere with child's ability to exercise; 21% of them stated that the siblings should also be investigated irrespective of the presence of a murmur. The mean Spielberger State-Trait Anxiety Inventory questionnaire score before pediatric cardiology consultation was 17.1 ± 4.3 and increased to 22.6 ± 2.8 after the consultation (Wilcoxon P < 0.001).
CONCLUSIONS
Parents of infants and children with innocent murmurs exhibit moderate levels of anxiety and this condition can be ameliorated significantly after pediatric cardiology consultation. Focused parental education is of paramount importance and the role of pediatric cardiologists is crucial and decisive.
Topics: Anxiety; Child; Heart Diseases; Heart Murmurs; Humans; Infant; Parents; Surveys and Questionnaires
PubMed: 33606333
DOI: 10.1111/ped.14664 -
Journal of the American Veterinary... May 2015
Review
Topics: Animals; Cat Diseases; Cats; Decision Trees; Diagnostic Techniques, Cardiovascular; Dog Diseases; Dogs; Heart Murmurs; Incidental Findings
PubMed: 25932933
DOI: 10.2460/javma.246.10.1076 -
The Journal of Pediatrics Jun 2022To assess the influence of diastolic dysfunction on the evolution of pulmonary hypertension in neonates with Down Syndrome over the early newborn period. (Observational Study)
Observational Study
OBJECTIVE
To assess the influence of diastolic dysfunction on the evolution of pulmonary hypertension in neonates with Down Syndrome over the early newborn period.
STUDY DESIGN
This was a prospective observational cohort study. Echocardiography was performed three times over the first week of life in both Down syndrome and control cohorts. Measurements of pulmonary arterial pressure in addition to left ventricular (LV) and right ventricular systolic and diastolic function were collected.
RESULTS
Seventy babies with Down syndrome and 60 control infants were enrolled. Forty-eight of the infants with Down syndrome (69%) were born with congenital heart disease (CHD). Echocardiography surrogates of pulmonary hypertension and myocardial function remained significantly impaired in the Down syndrome group in comparison with control infants (all P < .01). In the Down syndrome group, LV early diastolic strain rate was independently associated with measures of pulmonary hypertension while controlling for gestational age, cesarean delivery, and the presence of CHD (P < .01).
CONCLUSIONS
Intrinsic LV diastolic impairment is directly associated with higher indices of pulmonary hypertension in infants with Down syndrome and may be a contributing factor to its evolution.
Topics: Arterial Pressure; Diastole; Down Syndrome; Heart Murmurs; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Prospective Studies; Ventricular Dysfunction, Left
PubMed: 35176311
DOI: 10.1016/j.jpeds.2022.02.014 -
Identifying pediatric heart murmurs and distinguishing innocent from pathologic using deep learning.Artificial Intelligence in Medicine Jul 2024To develop a deep learning algorithm to perform multi-class classification of normal pediatric heart sounds, innocent murmurs, and pathologic murmurs.
OBJECTIVE
To develop a deep learning algorithm to perform multi-class classification of normal pediatric heart sounds, innocent murmurs, and pathologic murmurs.
METHODS
We prospectively enrolled children under age 18 being evaluated by the Division of Pediatric Cardiology. Parents provided consent for a deidentified recording of their child's heart sounds with a digital stethoscope. Innocent murmurs were validated by a pediatric cardiologist and pathologic murmurs were validated by echocardiogram. To augment our collection of normal heart sounds, we utilized a public database of pediatric heart sound recordings (Oliveira, 2022). We propose two novel approaches for this audio classification task. We train a vision transformer on either Markov transition field or Gramian angular field image representations of the frequency spectrum. We benchmark our results against a ResNet-50 CNN trained on spectrogram images.
RESULTS
Our final dataset consisted of 366 normal heart sounds, 175 innocent murmurs, and 216 pathologic murmurs. Innocent murmurs collected include Still's murmur, venous hum, and flow murmurs. Pathologic murmurs included ventricular septal defect, tetralogy of Fallot, aortic regurgitation, aortic stenosis, pulmonary stenosis, mitral regurgitation and stenosis, and tricuspid regurgitation. We find that the Vision Transformer consistently outperforms the ResNet-50 on all three image representations, and that the Gramian angular field is the superior image representation for pediatric heart sounds. We calculated a one-vs-rest multi-class ROC curve for each of the three classes. Our best model achieves an area under the curve (AUC) value of 0.92 ± 0.05, 0.83 ± 0.04, and 0.88 ± 0.04 for identifying normal heart sounds, innocent murmurs, and pathologic murmurs, respectively.
CONCLUSION
We present two novel methods for pediatric heart sound classification, which outperforms the current standard of using a convolutional neural network trained on spectrogram images. To our knowledge, we are the first to demonstrate multi-class classification of pediatric murmurs. Multiclass output affords a more explainable and interpretable model, which can facilitate further model improvement in the downstream model development cycle and enhance clinician trust and therefore adoption.
Topics: Humans; Deep Learning; Heart Murmurs; Child; Child, Preschool; Infant; Adolescent; Prospective Studies; Heart Sounds; Female; Male; Algorithms; Diagnosis, Differential; Heart Auscultation
PubMed: 38723434
DOI: 10.1016/j.artmed.2024.102867 -
Asian Cardiovascular & Thoracic Annals Jun 2021Diastolic mitral regurgitation is a unique Doppler finding that can be missed if special attention is not paid to it. There are a few causes of such abnormal flow,...
Diastolic mitral regurgitation is a unique Doppler finding that can be missed if special attention is not paid to it. There are a few causes of such abnormal flow, ranging from a conduction abnormality to abnormal valvular and left ventricle function. Failure to recognize it might lead to unnecessary investigations and delay the primary diagnosis. We are presenting a teaching case and discuss the associated pathology.
Topics: Diastole; Heart Murmurs; Humans; Mitral Valve Insufficiency
PubMed: 33108901
DOI: 10.1177/0218492320970759 -
Biosensors Jul 2022The biomedical acoustic signal plays an important role in clinical non-invasive diagnosis. In view of the deficiencies in early diagnosis of cardiovascular diseases,...
The biomedical acoustic signal plays an important role in clinical non-invasive diagnosis. In view of the deficiencies in early diagnosis of cardiovascular diseases, acoustic properties of and heart sounds are utilized. In this paper, we propose an integrated concave cilium MEMS heart sound sensor. The concave structure enlarges the area for receiving sound waves to improve the low-frequency sensitivity, and realizes the low-frequency and high-sensitivity characteristics of an MEMS heart sound sensor by adopting a reasonable acoustic package design, reducing the loss of heart sound distortion and faint heart murmurs, and improving the auscultation effect. Finally, experimental results show that the integrated concave ciliated MEMS heart sound sensor's sensitivity reaches -180.6 dB@500 Hz, as compared with the traditional bionic ciliated MEMS heart sound sensor; the sensitivity is 8.9 dB higher. The sensor has a signal-to-noise ratio of 27.05 dB, and has good heart sound detection ability, improving the accuracy of clinical detection methods.
Topics: Cilia; Heart; Heart Sounds; Micro-Electrical-Mechanical Systems; Signal-To-Noise Ratio
PubMed: 35884337
DOI: 10.3390/bios12070534 -
The Journal of Small Animal Practice Oct 2015
Review
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Echocardiography; Heart Murmurs; Incidental Findings; Mitral Valve Insufficiency
PubMed: 26456867
DOI: 10.1111/jsap.12405 -
Frontiers in Veterinary Science 2020Cardiac auscultation is an important, albeit underutilized tool in aquatic animal medicine due to the many challenges associated with in-water examinations. The aims of...
Cardiac auscultation is an important, albeit underutilized tool in aquatic animal medicine due to the many challenges associated with in-water examinations. The aims of this prospective study were to (1) establish an efficient and repeatable in-water cardiac auscultation technique in bottlenose dolphins (), (2) describe the presence and characterization of heart murmurs detected in free-ranging and managed dolphins, and (3) characterize heart murmur etiology through echocardiography in free-ranging dolphins. For technique development, 65 dolphins cared for by the Navy Marine Mammal Program (Navy) were auscultated. The techniques were then applied to two free-ranging dolphin populations during capture-release health assessments: Sarasota Bay, Florida (SB), a reference population, and Barataria Bay, LA (BB), a well-studied population of dolphins impacted by the oil spill. Systolic heart murmurs were detected at a frequent and similar prevalence in all dolphin populations examined (Navy 92%, SB 89%, and BB 88%), and characterized as fixed or dynamic. In all three populations, sternal cranial and left cranial were the most common locations for murmur point of maximal intensity (PMI). An in-water transthoracic echocardiogram technique was refined on a subset of Navy dolphins, and full echocardiographic exams were performed on 17 SB dolphins and 29 BB dolphins, of which, 40 had murmurs. Spectral Doppler was used to measure flow velocities across the outflow tracts, and almost all dolphins with audible murmurs had peak outflow velocities ≥1.6 m/s (95%, 38/40); three dolphins also had medium mitral regurgitation which could be the source of their murmurs. The presence of audible murmurs in most of the free-ranging dolphins (88%) was attributed to high velocity blood flow as seen on echocardiography, similar to a phenomenon described in other athletic species. These innocent murmurs were generally characterized as Grade I-III systolic murmurs with PMI in the left or sternal cranial region. This study is the first to describe an efficient technique for in-water dolphin cardiac auscultation, and to present evidence that heart murmurs are common in bottlenose dolphins.
PubMed: 33240948
DOI: 10.3389/fvets.2020.570055 -
Heart Failure Clinics Apr 2020Heart failure (HF) is a leading cause of hospitalization. Suitable pharmacologic management is critical. Distinct physical findings such as congestion and peripheral... (Review)
Review
Heart failure (HF) is a leading cause of hospitalization. Suitable pharmacologic management is critical. Distinct physical findings such as congestion and peripheral hypoperfusion need to be considered in selecting pharmacologic therapy. By applying the pretest probability and likelihood ratios of unique physical findings of HF to a Markov model, a definite posttest probability can be obtained. This article focuses on the findings of S3, jugular venous pressure, proportional pulse pressure, bendopnea, trepopnea, and various heart murmurs. Incorporating statistical precision in physical assessments, diagnoses of HF can be further refined, providing a sophisticated approach to evaluate patients hemodynamics status noninvasively.
Topics: Heart Failure; Hemodynamics; Humans; Markov Chains; Patient Selection; Physical Examination
PubMed: 32143759
DOI: 10.1016/j.hfc.2019.12.001