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International Journal of Cardiology Nov 2015
Topics: Algorithms; Aortic Valve Stenosis; Decision Support Systems, Clinical; Echocardiography; Heart Sounds; Humans; Mitral Valve Insufficiency; Phonocardiography; Primary Health Care; Reproducibility of Results; Severity of Illness Index; Stethoscopes; Systolic Murmurs
PubMed: 26151715
DOI: 10.1016/j.ijcard.2015.06.126 -
Tropical Medicine and Infectious Disease Jan 2023Infective endocarditis (IE) is a life-threatening condition caused by infection within the endocardium of the heart and commonly involves the valves. The subsequent...
Infective endocarditis (IE) is a life-threatening condition caused by infection within the endocardium of the heart and commonly involves the valves. The subsequent cascading inflammation leads to the appearance of a highly friable thrombus that is large enough to become lodged within the heart chambers. As a result, fever, fatigue, heart murmurs, and embolization phenomena may be seen in patients with IE. Embolization results in the seeding of bacteria and obstruction of circulation, causing cell ischemia. Of concern, bacteria with the potential to gain pan-drug resistance, such as methicillin-resistant (MRSA), are increasingly being identified as the causative agent of IE in hospitals and among intravenous drug abusers. We retrospectively reviewed de-identified clinical data to summarize the clinical course of a patient with MRSA isolated using an automated blood culture system. At the time of presentation, the patient showed a poor consciousness level, and the calculated Glasgow scale was 10/15. A high-grade fever with circulatory shock indicated an occult infection, and a systolic murmur was observed with peripheral signs of embolization. This case demonstrated the emerging threat of antimicrobial resistance in the community and revealed clinical findings of IE that may be helpful to clinicians for the early recognition of the disease. The management of such cases requires a multi-specialty approach, which is not widely available in small-island developing states such as the Maldives.
PubMed: 36668960
DOI: 10.3390/tropicalmed8010053 -
Anesthesia and Pain Medicine Jan 2024Systolic murmur suggesting the association of aortic valve (AV) stenosis or obstructive pathology in the left ventricular outflow tract (LVOT) usually requires...
BACKGROUND
Systolic murmur suggesting the association of aortic valve (AV) stenosis or obstructive pathology in the left ventricular outflow tract (LVOT) usually requires preoperative echocardiographic evaluation for elective surgery.
CASE
In a 63-year-old female patient undergoing elective thoracic surgery, the systolic murmur was auscultated on the right sternal border of the second intercostal space in the preoperative patient holding area. Point-of-care (POC) transthoracic echocardiography (TTE) demonstrated a systolic jet flow in the LVOT area. The peak systolic velocity of the continuous wave Doppler tracing, aligned to the LVOT and the AV, was approximately 1.5 m/s. The peak/mean pressure gradient was 11/6 mmHg for the AV and 9/5 mmHg for the LVOT. Anesthesia was induced under continuous TTE imaging. Intraoperative transesophageal echocardiography also confirmed the absence of any cardiac pathology.
CONCLUSIONS
POC echocardiography offered a thorough preoperative evaluation of an unexpectedly identified systolic murmur, avoiding a potential delay in the operation schedule for conventional preoperative echocardiographic evaluation.
PubMed: 38311356
DOI: 10.17085/apm.23124 -
Journal of the American Veterinary... Dec 2014To evaluate the usefulness of Doppler-derived peak flow velocity through the left ventricular outflow tract (LVOT Vmax) and effective orifice area indexed to body...
Comparison of peak flow velocity through the left ventricular outflow tract and effective orifice area indexed to body surface area in Golden Retriever puppies to predict development of subaortic stenosis in adult dogs.
OBJECTIVE
To evaluate the usefulness of Doppler-derived peak flow velocity through the left ventricular outflow tract (LVOT Vmax) and effective orifice area indexed to body surface area (EOAi) in puppies to predict development of subaortic stenosis (SAS) in the same dogs as adults.
DESIGN
Prospective, longitudinal, observational study.
ANIMALS
38 Golden Retrievers.
PROCEDURES
Cardiac auscultation and echocardiography were performed on 2- to 6-month-old puppies, then repeated at 12 to 18 months. Subaortic stenosis was diagnosed when LVOT Vmax was ≥ 2.3 m/s in adult dogs with left basilar systolic murmurs.
RESULTS
All puppies with EOAi < 1.46 cm(2)/m(2) had SAS as adults. All adults with EOAi < 1.29 cm(2)/m(2) had SAS. An LVOT Vmax > 2.3 m/s in puppyhood was 63% sensitive and 100% specific for SAS in adulthood. In puppies, LVOT Vmax was more strongly associated with a future diagnosis of SAS (area under the curve [AUC], 0.89) than was EOAi (AUC, 0.80). In puppies, the combination of LVOT Vmax and EOAi yielded slightly higher sensitivity (69%) and specificity (100%) for adult SAS than did LVOT Vmax alone. In unaffected and affected dogs, LVOT Vmax increased significantly from puppyhood to adulthood but EOAi did not.
CONCLUSIONS AND CLINICAL RELEVANCE
In Golden Retriever puppies, LVOT Vmax > 2.3 m/s and EOAi < 1.46 cm(2)/m(2) were both associated with a diagnosis of SAS at adulthood. The combination of these 2 criteria may result in higher sensitivity for SAS screening. Unlike LVOT Vmax, EOAi did not change during growth in either unaffected Golden Retrievers or those with SAS.
Topics: Animals; Blood Flow Velocity; Body Surface Area; Discrete Subaortic Stenosis; Dog Diseases; Dogs; Female; Heart Ventricles; Male
PubMed: 25459481
DOI: 10.2460/javma.245.12.1367 -
Anatolian Journal of Cardiology May 2016Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic measurement used for evaluating right ventricular systolic function. While established...
OBJECTIVE
Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic measurement used for evaluating right ventricular systolic function. While established reference values of TAPSE exist for the adult population, only a limited number of studies have attempted to evaluate reference values for the pediatric population. The aim of the present study was to determine the reference values for TAPSE in healthy children in Turkey.
METHODS
A total of 765 healthy children aged between 0 and 18 years, all of whom were referred to our clinic with cardiac murmurs, were evaluated prospectively. Patients with no cardiac pathologies or other disorders were excluded from the study. The measurement of TAPSE was obtained using a 2D-guided M-mode technique with echocardiography, and the relationship between age and surface area with TAPSE was investigated. The statistical analysis was carried out using the SPSS 20.0 software package (SPSS Inc., Chicago, IL, USA, 2012).
RESULTS
The mean TAPSE value was found to be 19.56±5.54 mm, and no significant difference was identified between male and female children. TAPSE values showed a positive correlation with increasing age and surface area. The mean TAPSE value was 9.09±1.36 mm in newborns and 25.91±3.60 mm in the 13-18 years age group. A negative correlation was seen between TAPSE and heart rate.
CONCLUSION
In the present study, the reference values for TAPSE in healthy Turkish children were presented in percentile tables and the corresponding z-scores were determined. These reference values may be useful in daily practice for the evaluation of right ventricular systolic function in children.
Topics: Adolescent; Child; Child, Preschool; Echocardiography; Female; Humans; Infant; Infant, Newborn; Male; Reference Values; Systole; Tricuspid Valve; Turkey; Ventricular Function, Right
PubMed: 26488383
DOI: 10.5152/akd.2015.6227 -
Medicine Jun 2018Cardiac myxomas are the most frequent primary cardiac tumor in adults. The incidence in pediatric patients is extremely low. Heavy calcification of an atrial myxoma is...
INTRODUCTION
Cardiac myxomas are the most frequent primary cardiac tumor in adults. The incidence in pediatric patients is extremely low. Heavy calcification of an atrial myxoma is uncommon in children.
CASE PRESENTATION
An 18-month-old boy was admitted for a significant precordial systolic murmur. Transthoracic echocardiography revealed a cardiac mass extending from the inferior vena cava across the right atrium and tricuspid valve into the right ventricle with severe tricuspid regurgitation. According to the echocardiography result, the patient was diagnosed with an inferior vena cava and right atrial tumor with tricuspid regurgitation. After the diagnosis, the patient underwent removal of the tumor via median sternotomy. The mass was removed under cardiopulmonary bypass with deep hypothermia circulatory arrest. The tricuspid valve was repaired by valvuloplasty and annuloplasty. The postoperative recovery was unremarkable. Follow-up echocardiogram at 1 month revealed moderate tricuspid regurgitation without myxoma recurrence.
CONCLUSION
Heavy calcification of an atrial myxoma is uncommon especially in children. Definitive therapy for myxomas requires prompt surgical excision and long-term follow-up is recommended in children although recurrence after excision is rare.
Topics: Calcinosis; Echocardiography; Heart Murmurs; Heart Neoplasms; Humans; Infant; Male; Myxoma; Sternotomy; Tricuspid Valve Insufficiency; Vena Cava, Inferior
PubMed: 29924000
DOI: 10.1097/MD.0000000000011073 -
BMJ Case Reports Jul 2015Cardiac haemangiomas are extremely rare and account for approximately 2% of all primary resected cardiac tumours. They can occur in any chamber and at any level, from...
Cardiac haemangiomas are extremely rare and account for approximately 2% of all primary resected cardiac tumours. They can occur in any chamber and at any level, from pericardium to endocardium. Myocardial contrast echocardiography is an imaging tool for the assessment of myocardial microcirculation. It can also be used for the evaluation of the relative perfusion of a cardiac mass. We report a case of a 17-year-old male patient who was referred for cardiological evaluation because of a 2/6 systolic murmur. Transthoracic echocardiography revealed a mass in the left ventricle. Using myocardial perfusion contrast echocardiography, the mass was rapidly filled with contrast greater than the adjacent myocardium, suggesting intense vascularisation. The mass was successfully resected and the subsequent histopathological examination showed a cardiac haemangioma. Therefore, myocardial perfusion contrast echocardiography appears to be a valuable diagnostic tool in differentiating the different types of cardiac masses.
Topics: Adolescent; Contrast Media; Echocardiography; Heart Murmurs; Heart Neoplasms; Heart Ventricles; Hemangioma; Humans; Male; Myocardium
PubMed: 26148494
DOI: 10.1136/bcr-2015-210075 -
Journal of Medical Case Reports Nov 2014Hospitalists are frequently consulted on postoperative patients with hypotension. Postoperative hypotension is common and can be due to variety of causes. Systolic...
INTRODUCTION
Hospitalists are frequently consulted on postoperative patients with hypotension. Postoperative hypotension is common and can be due to variety of causes. Systolic anterior motion of the mitral valve leading to left ventricular outflow tract obstruction is a rare cause of postoperative hypotension and can occur without prior structural heart disease. A high index of suspicion can lead to early recognition of this unique condition.
CASE PRESENTATION
A 90-year-old Caucasian woman with no known structural heart abnormality was admitted to the intensive care unit with hypotension after a left hip arthroplasty revision. A transthoracic echocardiogram revealed systolic anterior motion of the mitral valve and dynamic left ventricular outflow tract obstruction as the likely cause of her hypotension. Our patient was treated with fluid resuscitation and phenylephrine with improvement in blood pressure. A repeat echocardiogram on postoperative day 5 showed resolution of the left ventricular outflow tract obstruction. Intraoperative vasodilatation and volume loss that caused underfilling of the left ventricle likely led to dynamic outflow tract obstruction in our patient.
CONCLUSIONS
Hospitalists should be aware of systolic anterior motion of the mitral valve as a rare peri-operative complication in patients with or without underlying cardiac pathology as it is treated differently than other causes of peri-operative hypotension. Clinical suspicion, early recognition, and prompt treatment can improve clinical outcomes in these patients.
Topics: Aged, 80 and over; Arthroplasty, Replacement, Hip; Cardiotonic Agents; Diagnosis, Differential; Echocardiography; Female; Heart Murmurs; Humans; Hypotension; Phenylephrine; Reoperation; Ventricular Outflow Obstruction
PubMed: 25384414
DOI: 10.1186/1752-1947-8-363 -
Annals of Noninvasive Electrocardiology... Sep 2015Isolated left ventricular (LV) apical hypoplasia is a unusual and recently recognized congenital cardiac anomaly. A 19-year-old man was found to have an abnormal ECG and...
Isolated left ventricular (LV) apical hypoplasia is a unusual and recently recognized congenital cardiac anomaly. A 19-year-old man was found to have an abnormal ECG and cardiac murmur identified during a routine health check since joining work. His ECG revealed normal sinus rhythm, right-axis deviation, poor R wave progression, and T wave abnormalities. On physical examination, a 2/6~3/6 systolic murmur was heard at the second intercostal space along the left sternal border. Subsequent echocardiography and cardiac magnetic resonance imaging confirmed the LV apical hypoplasia. Of note, we first found that LV apical hypoplasia was accompanied by RV outflow tract obstruction due to exaggerated rightward bulging of the basal-anterior septum during systole. A close follow-up was performed for the development of heart failure, pulmonary hypertension, and potentially tachyarrhythmia.
Topics: Electrocardiography; Heart Defects, Congenital; Heart Murmurs; Heart Ventricles; Humans; Male; Ventricular Outflow Obstruction; Young Adult
PubMed: 26417869
DOI: 10.1111/anec.12234 -
Medicine Nov 2017High take-off of the coronary arteries is a rare cardiac anatomic anomaly, which may occur independently or with other congenital heart defects. In the clinical setting,...
RATIONALE
High take-off of the coronary arteries is a rare cardiac anatomic anomaly, which may occur independently or with other congenital heart defects. In the clinical setting, it is noteworthy as a cause of sudden cardiac death. Further, it is vital to identify such anomalies to avoid intraoperative catastrophes in surgeries for congenital heart defects.
PATIENT CONCERNS
A II/6 systolic heart murmur on physical examination was incidentally found in a 9-year-old boy; he was confirmed to have a secundum-type atrial septal defect on echocardiography. He was referred to our institution for elective surgery.
DIAGNOSES
The preoperative echocardiogram confirmed the presence of an atrial septal defect, and during the surgical procedure, a high take-off right coronary artery was found.
INTERVENTIONS
The atrial septal defect was closed surgically, and care was taken to avoid clamping the anomalous right coronary artery when placing the aortic cross-clamp.
OUTCOMES
Postoperative echocardiogram verified the presence of the high take-off right coronary artery and a satisfactory repair of the atrial septal defect. The postoperative course was uneventful, and the patient was discharged on postoperative day 5.
LESSONS
This case suggests that it is critical to perform echocardiography to assess the anatomy of the coronary arteries, especially in pediatric cardiac patients. In addition, multi-detector computed tomography may be considered if appropriate. Care should be taken to assess the coronary anatomy for anomalies during interventional therapy or surgery, especially in congenital cases.
Topics: Child; Coronary Vessel Anomalies; Echoencephalography; Heart Murmurs; Heart Septal Defects, Atrial; Humans; Incidental Findings; Male
PubMed: 29137093
DOI: 10.1097/MD.0000000000008614