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Brazilian Journal of Cardiovascular... Apr 2021We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE)...
INTRODUCTION
We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center.
METHOD
We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018.
RESULTS
The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%.
CONCLUSION
We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.
Topics: Endocarditis; Endocarditis, Bacterial; Humans; Infant; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus
PubMed: 33113327
DOI: 10.21470/1678-9741-2020-0035 -
The American Journal of Case Reports Mar 2022BACKGROUND This report presents a rare case of a traumatic innominate artery to left innominate vein fistula following a stab wound to the base of the neck. CASE REPORT...
BACKGROUND This report presents a rare case of a traumatic innominate artery to left innominate vein fistula following a stab wound to the base of the neck. CASE REPORT We report a case of a 23-year-old patient with a traumatic innominate-innominate arteriovenous fistula, after being stabbed in the suprasternal notch area 3 years prior. The patient presented with fatigue, and shortness of breath on exertion. Examination revealed a wide pulse pressure, bounding pulses, and a continuous murmur on the upper sternal area. Chest X-rays, echocardiography, CT angiography, and cardiac catheterization were useful to aid in diagnosis and work-up for fistula repair. A complex 8-mm fistula between the left innominate vein and the proximal innominate artery was noted, with multiple tortuous channels and demonstrating a reversible left-to-right shunt. After medical optimization, successful surgical ligation and division of the fistula was done through median sternotomy without cardiopulmonary bypass. The postoperative recovery was uneventful. CONCLUSIONS Traumatic innominate-innominate arteriovenous fistulas are rare and can pose a diagnostic challenge. High index of suspicion, careful history, examination, and radiologic evaluation usually result in correct diagnosis. Endovascular and surgical approaches are the mainstay treatment.
Topics: Adult; Arteriovenous Fistula; Brachiocephalic Veins; Computed Tomography Angiography; Heart Murmurs; Humans; Wounds, Stab; Young Adult
PubMed: 35264551
DOI: 10.12659/AJCR.934270 -
Computers in Biology and Medicine Apr 2016A phonocardiogram (PCG) signal can be recorded for long-term heart monitoring. A huge amount of data is produced if the time of a recording is as long as days or weeks....
BACKGROUND
A phonocardiogram (PCG) signal can be recorded for long-term heart monitoring. A huge amount of data is produced if the time of a recording is as long as days or weeks. It is necessary to compress the PCG signal to reduce storage space in a record and play system. In another situation, the PCG signal is transmitted to a remote health care center for automatic analysis in telemedicine. Compression of the PCG signal in that situation is necessary as a means for reducing the amount of data to be transmitted. Since heart beats are of a cyclical nature, compression can make use of the similarities in adjacent cycles by eliminating repetitive elements as redundant. This study proposes a new compression method that takes advantage of these repetitions.
METHODS
Data compression proceeds in two stages, a training stage followed by the compression as such. In the training stage, a section of the PCG signal is selected and its sounds and murmurs (if any) decomposed into time-frequency components. Basic components are extracted from these by clustering and collected to form a dictionary that allows the generative reconstruction and retrieval of any heart sound or murmur. In the compression stage, the heart sounds and murmurs are reconstructed from the basic components stored in the dictionary. Compression is made possible because only the times of occurrence and the dictionary indices of the basic components need to be stored, which greatly reduces the number of bits required to represent heart sounds and murmurs. The residual that cannot be reconstructed in this manner appears as a random sequence and is further compressed by vector quantization. What we propose are quick search parameters for this vector quantization.
RESULTS
For normal PCG signals the compression ratio ranges from 20 to 149, for signals with median murmurs it ranges from 14 to 35, and for those with heavy murmurs, from 8 to 20, subject to a degree of distortion of ~5% (in percent root-mean-square difference) and a sampling frequency of 4kHz.
DISCUSSION
We discuss the selection of the training signal and the contribution of vector quantization. Performance comparisons between the method proposed in this study and existing methods are conducted by computer simulations.
CONCLUSIONS
When recording and compressing cyclical sounds, any repetitive components can be removed as redundant. The redundancies in the residual can be reduced by vector quantization. The method proposed in this study achieves a better performance than existing methods.
Topics: Heart Murmurs; Phonocardiography; Signal Processing, Computer-Assisted; Smartphone; Sound; Telemedicine
PubMed: 26871603
DOI: 10.1016/j.compbiomed.2016.01.017 -
Heart (British Cardiac Society) Jan 2019We aimed to determine if auscultation or a point-of-care scan could reduce the need for standard echocardiography (transthoracic echocardiogram (TTE)) in community...
OBJECTIVES
We aimed to determine if auscultation or a point-of-care scan could reduce the need for standard echocardiography (transthoracic echocardiogram (TTE)) in community patients with asymptomatic murmurs.
METHODS
Requests from general practitioners were directed to a new murmur clinic. Auscultation and a point-of-care scan were performed by a cardiologist between 1 October 2013 and 31 December 2014 and by a scientist between 21 July 2015 and 9 May 2017.
RESULTS
In the first phase (cardiologist), there were 75 patients, mean age 54 (56 women), and in the second phase there were 100 patients, mean age 60 (76 women). In the total population of 175, abnormalities were shown on TTE in 52 (30%), on point-of-care scan in 52 (30%) and predicted on auscultation in 45 (26%) (p=0.125; 95% CI -0.02 to 0.29). The sensitivity of auscultation was not significantly different for the cardiologist (91%) as for the scientist (83%) (p=0.18; 95% CI -0.22 to 0.175) and the specificity was 100% for both. Accuracy was 97% for the cardiologist and 95% for the scientist. For the point-of-care scan, the sensitivity, specificity, positive and negative predictive values and accuracy were 100% for both cardiologist and scientist.
CONCLUSION
Most patients in a specialist murmur clinic had normal auscultation and point-of-care scans and no additional valve disease was detected by standard echocardiography. This suggests that a murmur clinic is a valid model for reducing demand on hospital echocardiography services.
Topics: Echocardiography; Female; Heart Auscultation; Heart Murmurs; Heart Valve Diseases; Humans; Male; Medical Overuse; Middle Aged; Point-of-Care Testing; Predictive Value of Tests; Reproducibility of Results; Sensitivity and Specificity; United Kingdom
PubMed: 30049836
DOI: 10.1136/heartjnl-2018-313393 -
Animals : An Open Access Journal From... Apr 2024Auscultation of heart sounds is an important veterinary skill requiring an understanding of anatomy, physiology, pathophysiology and pattern recognition. This...
Auscultation of heart sounds is an important veterinary skill requiring an understanding of anatomy, physiology, pathophysiology and pattern recognition. This cross-sectional study was developed to evaluate a targeted, audio-visual training resource for veterinary students to improve their understanding and auscultation of common heart conditions in horses. Fourth- and fifth-year 2021 and 2022 Bachelor of Veterinary Science students at the University of Queensland (UQ) were provided the learning resource and surveyed via online pre- and post-intervention surveys. Results were quantitatively analyzed using descriptive statistics and Mann-Whitney U tests. Open-ended survey questions were qualitatively analyzed by thematic analysis and Leximancer™ Version 4 program software analysis. Over the two-year period, 231 fourth-year and 222 fifth-year veterinary students had access to the resource; 89 completed the pre-intervention survey and 57 completed the post-intervention survey. Quantitative results showed the resource helped students prepare for practicals and their perception of competency and confidence when auscultating equine cardiac sounds improved ( < 0.05). Compared to fifth-year students, fourth-year students felt less competent at identifying murmurs and arrythmias prior to accessing the learning resource ( < 0.05). Fourth-year and fifth-year students' familiarity with detection of murmurs improved after completing the learning resource ( < 0.001). Qualitative analysis demonstrated a limited number of opportunities to practice equine cardiac auscultation throughout the veterinary degree, especially during the COVID-19 pandemic, and that integrated audio-visual resources are an effective means of teaching auscultation.
PubMed: 38731348
DOI: 10.3390/ani14091341 -
BMC Medical Education Dec 2021We have provided fourth-year medical students with a three-hour cardiac auscultation class using a cardiology patient simulator since 2010. The test results of 2010-2012...
Employment of color Doppler echocardiographic video clips in a cardiac auscultation class with a cardiology patient simulator: discrepancy between students' satisfaction and learning.
BACKGROUND
We have provided fourth-year medical students with a three-hour cardiac auscultation class using a cardiology patient simulator since 2010. The test results of 2010-2012 revealed that as compared with aortic stenosis murmur, students correctly identified murmurs of other valvular diseases less often. We investigated whether employment of color Doppler echocardiographic video clips would improve proficiency in identifying murmurs of aortic regurgitation and mitral regurgitation, and whether students' favorable responses to a questionnaire were associated with improved proficiency.
METHODS
A total of 250 fourth-year medical students were divided into groups of 7-9 students in 2014 and 2015. Each group attended a three-hour cardiac auscultation class comprising a mini-lecture, facilitated training, two different auscultation tests (the second test being closer to clinical setting than the first) and a questionnaire. We provided each student with color Doppler echocardiographic videos of aortic regurgitation and mitral regurgitation using a tablet computer, which they freely referred to before and after listening to corresponding murmurs. The test results were compared with those in 2010-2012. The students had already completed the course of cardiovascular medicine, comprising lectures including those of physical examination, echocardiography, and valvular heart diseases, before participating in this auscultation training class.
RESULTS
Most students indicated that the videos were useful or somewhat useful regarding aortic regurgitation (86.3%) and mitral regurgitation (85.7%). The accuracy rates were 78.4% (81.2% in 2010-2012) in aortic regurgitation and 76.0% (77.8%) in mitral regurgitation in the first test, and 83.3% (71.4%) in aortic regurgitation and 77.1% (77.6%) in mitral regurgitation in the second test, showing no significant differences as compared to 2010-2012. Overall accuracy rate of all heart sounds and murmurs in the first test and that of second/third/fourth sounds in the first and second tests were significantly lower in 2014-2015 than in 2010-2012.
CONCLUSIONS
Referring to color Doppler echocardiographic video clips in the way employed in the present study, which most students regarded as useful, did not improve their proficiency in identifying the two important regurgitant murmurs, revealing a discrepancy between students' satisfaction and learning. Video clips synchronized with their corresponding murmurs may contribute toward improving students' proficiency.
Topics: Cardiology; Echocardiography; Employment; Heart Auscultation; Humans; Patient Satisfaction; Personal Satisfaction; Students, Medical
PubMed: 34872540
DOI: 10.1186/s12909-021-03033-8 -
Detecting Aortic Valve Anomaly From Induced Murmurs: Insights From Computational Hemodynamic Models.Frontiers in Physiology 2021Patients who receive transcatheter aortic valve replacement are at risk for leaflet thrombosis-related complications, and can benefit from continuous, longitudinal...
Patients who receive transcatheter aortic valve replacement are at risk for leaflet thrombosis-related complications, and can benefit from continuous, longitudinal monitoring of the prosthesis. Conventional angiography modalities are expensive, hospital-centric and either invasive or employ potentially nephrotoxic contrast agents, which preclude their routine use. Heart sounds have been long recognized to contain valuable information about individual valve function, but the skill of auscultation is in decline due to its heavy reliance on the physician's proficiency leading to poor diagnostic repeatability. This subjectivity in diagnosis can be alleviated using machine learning techniques for anomaly detection. We present a computational and data-driven proof-of-concept analysis of a novel, auscultation-based technique for monitoring aortic valve, which is practical, non-invasive, and non-toxic. However, the underlying mechanisms leading to physiological and pathological heart sounds are not well-understood, which hinders development of such a technique. We first address this by performing direct numerical simulations of the complex interactions between turbulent blood flow in a canonical ascending aorta model and dynamic valve motion in 29 cases with healthy and stenotic valves. Using the turbulent pressure fluctuations on the aorta lumen boundary, we model the propagation of heart sounds, as elastic waves, through the patient's thorax. The heart sound may be recorded on the epidermal surface using a stethoscope/phonocardiograph. This approach allows us to correlate instantaneous hemodynamic phenomena and valve motion with the acoustic response. From this dataset we extract "acoustic signatures" of healthy and stenotic valves based on principal components of the recorded sound. These signatures are used to train a linear discriminant classifier by maximizing correlation between recorded heart sounds and valve status. We demonstrate that this classifier is capable of accurate prospective detection of anomalous valve function and that the principal component-based signatures capture prominent audible features of heart sounds, which have been historically used by physicians for diagnosis. Further development of such technology can enable inexpensive, safe and patient-centric at-home monitoring, and can extend beyond transcatheter valves to surgical as well as native valves.
PubMed: 34690809
DOI: 10.3389/fphys.2021.734224 -
Journal of Veterinary Research Sep 2017Older small breed dogs are considered at risk for heart failure secondary to chronic mitral valve disease. However, few data are available on the onset of this disease...
INTRODUCTION
Older small breed dogs are considered at risk for heart failure secondary to chronic mitral valve disease. However, few data are available on the onset of this disease in such dogs. This study was performed to determine if auscultation alone can be used to eliminate clinically relevant mitral valve regurgitation seen in echocardiography in Dachshund dogs.
MATERIAL AND METHODS
Clinical and echocardiographic data were obtained from 107 dogs without heart murmurs.
RESULTS
The study revealed that 63.6% of the dogs had mitral regurgitation. Numbers increased with age and a larger percentage of male Dachshunds were affected than female Dachshunds. Mitral valve prolapse and thickening were mild, and the regurgitant area inextensive in most dogs.
CONCLUSIONS
The study shows that mitral valve regurgitation is prevalent (63.6%) in Dachshunds without heart murmurs. Typical lesions often become apparent during echocardiographic examinations in dogs under 5 years of age.
PubMed: 29978096
DOI: 10.1515/jvetres-2017-0048 -
Journal of Cardiology Jan 2015Right ventricular outflow tract (RVOT) stenosis and pulmonary regurgitation (PR) are important residua and sequelae in adult tetralogy of Fallot (TOF) patients.... (Comparative Study)
Comparative Study
BACKGROUND
Right ventricular outflow tract (RVOT) stenosis and pulmonary regurgitation (PR) are important residua and sequelae in adult tetralogy of Fallot (TOF) patients. Auscultation of the heart sound is a useful tool to detect and evaluate these lesions, but there was no previous report regarding heart sound in adult TOF.
METHODS
We enrolled consecutive TOF outpatients from January 2013 to October 2013 in our adult congenital heart disease clinic. Phonocardiogram with phono-recording was performed with MES-1000 (Fukuda-Denshi Co., Tokyo, Japan), and compared heart sound with echocardiographic parameters.
RESULTS
A total of 30 TOF patients were enrolled [age, 34.7±12.8 years; 14 males (46.7%)]. In all 30 patients, phonocardiography was clearly recorded. Eighteen patients (60.0%) had the single second heart sound, which was more frequently observed before than after pulmonary valve reoperation (75.0% vs 11.1%). The single second heart sound was also associated with PR. In 18/30 (60%), diastolic murmur was associated with moderate PR (p=0.008). In 14/30 (46.7%), systolic murmur was associated with moderate RVOT stenosis (p=0.012).
CONCLUSION
Phonocardiogram was a useful tool to detect RVOT lesions. We should listen to heart sound carefully especially focusing on the second heart sound, systolic, and diastolic murmur.
Topics: Adolescent; Adult; Diastole; Female; Heart Murmurs; Heart Sounds; Humans; Male; Middle Aged; Phonocardiography; Pulmonary Valve Insufficiency; Severity of Illness Index; Systole; Tetralogy of Fallot; Ventricular Outflow Obstruction; Young Adult
PubMed: 24842232
DOI: 10.1016/j.jjcc.2014.03.011