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The Nursing Clinics of North America Sep 2023Many healthy children may be found to have a murmur on physical exam. Whether this murmur is discovered at a routine health maintenance visit or as a result of a focused... (Review)
Review
Many healthy children may be found to have a murmur on physical exam. Whether this murmur is discovered at a routine health maintenance visit or as a result of a focused exam on a child with illness, it is just one finding and must be considered in the context of the child's history and other physical exam findings. Murmurs associated with heart defect or dysfunction occur most often in infancy. Most murmurs discovered in children, especially after infancy, between ages 3 to 6 and in young-adulthood, are innocent or benign murmurs and less likely a symptom of cardiac dysfunction or defect.
Topics: Child; Humans; Adult; Heart Auscultation; Heart Murmurs; Heart Diseases; Physical Examination
PubMed: 37536793
DOI: 10.1016/j.cnur.2023.05.013 -
Clinical Anatomy (New York, N.Y.) Jan 2024Ventricular false tendons are fibromuscular structures that travel across the ventricular cavity. Left ventricular false tendons (LVFTs) have been examined through gross... (Meta-Analysis)
Meta-Analysis Review
Ventricular false tendons are fibromuscular structures that travel across the ventricular cavity. Left ventricular false tendons (LVFTs) have been examined through gross dissection and echocardiography. This study aimed to comprehensively evaluate the prevalence, morphology, and clinical importance of ventricular false tendons using a systematic review. In multiple studies, these structures have had a wide reported prevalence ranging from less than 1% to 100% of cases. This meta-analysis found the overall pooled prevalence of LVFTs to be 30.2%. Subgroup analysis indicated the prevalence to be 55.1% in cadaveric studies and 24.5% in living patients predominantly studied by echocardiography. Morphologically, left and right ventricular false tendons have been classified into several types based on their location and attachments. Studies have demonstrated false tendons have important clinical implications involving innocent murmurs, premature ventricular contractions, early repolarization, and impairment of systolic and diastolic function. Despite these potential complications, there is evidence demonstrating that the presence of false tendons can lead to positive clinical outcomes.
Topics: Humans; Heart Ventricles; Heart Defects, Congenital; Echocardiography; Clinical Relevance; Dissection
PubMed: 37819143
DOI: 10.1002/ca.24116 -
Tidsskrift For Den Norske Laegeforening... Feb 2024Ventricular septal rupture (VSR) following acute myocardial infarction is rare in the modern revascularisation era. Nevertheless, clinical awareness is paramount, as...
BACKGROUND
Ventricular septal rupture (VSR) following acute myocardial infarction is rare in the modern revascularisation era. Nevertheless, clinical awareness is paramount, as presentation may vary.
CASE PRESENTATION
A middle-aged male with no history of cardiovascular disease developed progressive heart failure symptoms while travelling abroad. Initial workup revealed a prominent systolic murmur, but findings were inconsistent with acute coronary syndrome. Transthoracic echocardiogram showed a small hypokinetic area in the basal septum, preserved left ventricular function and no significant valvulopathy. Despite the absence of chest pain, an invasive angiography revealed occlusion of a septal branch emerging from the left anterior descending artery, otherwise patent coronary arteries. Despite administration of diuretics, the patient remained symptomatic and presented two months later to his primary care provider with a persisting systolic murmur. He was subsequently referred to the outpatient cardiology clinic where echocardiography revealed a large VSR involving the basal anteroseptum of the left ventricle with a significant left-to-right shunt. After accurate radiological and haemodynamic assessment of the defect, he successfully underwent elective surgical repair.
INTERPRETATION
Although traditionally associated with large transmural myocardial infarctions, VSR may arise also from minor, subclinical events. A new-onset murmur is a valuable hint for the alert clinician.
Topics: Humans; Male; Middle Aged; Systolic Murmurs; Myocardial Infarction; Ventricular Septal Rupture; Echocardiography; Dyspnea
PubMed: 38349103
DOI: 10.4045/tidsskr.23.0373 -
PLOS Digital Health Sep 2023Cardiac auscultation is an accessible diagnostic screening tool that can help to identify patients with heart murmurs, who may need follow-up diagnostic screening and... (Review)
Review
Cardiac auscultation is an accessible diagnostic screening tool that can help to identify patients with heart murmurs, who may need follow-up diagnostic screening and treatment for abnormal cardiac function. However, experts are needed to interpret the heart sounds, limiting the accessibility of cardiac auscultation in resource-constrained environments. Therefore, the George B. Moody PhysioNet Challenge 2022 invited teams to develop algorithmic approaches for detecting heart murmurs and abnormal cardiac function from phonocardiogram (PCG) recordings of heart sounds. For the Challenge, we sourced 5272 PCG recordings from 1452 primarily pediatric patients in rural Brazil, and we invited teams to implement diagnostic screening algorithms for detecting heart murmurs and abnormal cardiac function from the recordings. We required the participants to submit the complete training and inference code for their algorithms, improving the transparency, reproducibility, and utility of their work. We also devised an evaluation metric that considered the costs of screening, diagnosis, misdiagnosis, and treatment, allowing us to investigate the benefits of algorithmic diagnostic screening and facilitate the development of more clinically relevant algorithms. We received 779 algorithms from 87 teams during the Challenge, resulting in 53 working codebases for detecting heart murmurs and abnormal cardiac function from PCG recordings. These algorithms represent a diversity of approaches from both academia and industry, including methods that use more traditional machine learning techniques with engineered clinical and statistical features as well as methods that rely primarily on deep learning models to discover informative features. The use of heart sound recordings for identifying heart murmurs and abnormal cardiac function allowed us to explore the potential of algorithmic approaches for providing more accessible diagnostic screening in resource-constrained environments. The submission of working, open-source algorithms and the use of novel evaluation metrics supported the reproducibility, generalizability, and clinical relevance of the research from the Challenge.
PubMed: 37695769
DOI: 10.1371/journal.pdig.0000324 -
JAMA Pediatrics Aug 2023
Topics: Child; Humans; Heart Murmurs; Referral and Consultation
PubMed: 37358864
DOI: 10.1001/jamapediatrics.2023.1376 -
Journal of Medical Engineering &... Jul 2023Phonocardiogram signal (PCG) has been the subject of several signal processing studies, where researchers applied various analysis techniques and extracted numerous...
Phonocardiogram signal (PCG) has been the subject of several signal processing studies, where researchers applied various analysis techniques and extracted numerous features for different purposes, like cardiac pathologies identification, healthy/pathologic case discrimination, and severity assessment. When talking about cardiac severity, many think directly about the intensity or energy of the signal as the most reliable parameter. However, cardiac severity is not always reflected by the intensity or energy of the signal but includes other variables as well. In this paper, we will discuss the probability of having a Discrete Wavelet Transform (DWT) parameter that discriminates, identifies, and assesses the pathological cardiac severity levels, a parameter that takes into consideration other variables and elements for the severity study. For this purpose, we studied six PCGs signals that contain reduced murmurs (clicks) and eight murmur signals with four different cardiac severity levels. We extracted the Entropy of Approximation Coefficients (EAC) from the Discrete Wavelet Transform (DWT) sub-bands as the feature to study in this novel approach. The Energetic Ratio (ER) served as a reference parameter to evaluate the EAC evolution, due to its proven efficiency in cardiac severity tracking. While the DWT-EAC algorithm results revealed that the EAC provides better results for the paper purposes, the One versus All Support Vector Machine (OVA-SVM) classifier affirmed the efficiency of the Entropy of Approximation Coefficients (EAC) for cardiac severity assessment and proved the accuracy of this novel approach.
Topics: Humans; Signal Processing, Computer-Assisted; Wavelet Analysis; Heart Murmurs; Algorithms; Probability
PubMed: 38393735
DOI: 10.1080/03091902.2024.2310157 -
Cardiology in the Young Apr 2024Left ventricular tumour is a rare condition in children. The causes include vegetations, thrombus, and fibroma. 2-year-old asymptomatic female presented with an innocent...
Left ventricular tumour is a rare condition in children. The causes include vegetations, thrombus, and fibroma. 2-year-old asymptomatic female presented with an innocent heart murmur at 6 months of age. Subsequent follow-ups at 18 months of age showed left ventricular mass. Surgical pathology revealed "nodular fasciitis." This type of tumour has never been described in the heart before.
Topics: Child; Humans; Female; Child, Preschool; Fasciitis; Heart Neoplasms; Fibroma; Heart Ventricles; Heart Murmurs
PubMed: 38282536
DOI: 10.1017/S1047951124000052 -
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 -
Journal of Cardiology Apr 2024In the aging global society, heart failure and valvular heart diseases, including aortic stenosis, are affecting millions of people and healthcare systems worldwide.... (Review)
Review
In the aging global society, heart failure and valvular heart diseases, including aortic stenosis, are affecting millions of people and healthcare systems worldwide. Although the number of effective treatment options has increased in recent years, the lack of effective screening methods is provoking continued high mortality and rehospitalization rates. Appropriately, auscultation has been the primary option for screening such patients, however, challenges arise due to the variability in auscultation skills, the objectivity of the clinical method, and the presence of sounds inaudible to the human ear. To address challenges associated with the current approach towards auscultation, the hardware of Super StethoScope was developed. This paper is composed of (1) a background literature review of bioacoustic research regarding heart disease detection, (2) an introduction of our approach to heart sound research and development of Super StethoScope, (3) a discussion of the application of remote auscultation to telemedicine, and (4) results of a market needs survey on traditional and remote auscultation. Heart sounds and murmurs, if collected properly, have been shown to closely represent heart disease characteristics. Correspondingly, the main characteristics of Super StethoScope include: (1) simultaneous collection of electrocardiographic and heart sound for the detection of heart rate variability, (2) optimized signal-to-noise ratio in the audible frequency bands, and (3) acquisition of heart sounds including the inaudible frequency ranges. Due to the ability to visualize the data, the device is able to provide quantitative results without disturbance by sound quality alterations during remote auscultations. An online survey of 3648 doctors confirmed that auscultation is the common examination method used in today's clinical practice and revealed that artificial intelligence-based heart sound analysis systems are expected to be integrated into clinicians' practices. Super StethoScope would open new horizons for heart sound research and telemedicine.
Topics: Humans; Stethoscopes; Heart Sounds; Artificial Intelligence; Auscultation; Heart Diseases; Heart Auscultation
PubMed: 37734656
DOI: 10.1016/j.jjcc.2023.09.007