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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 -
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 the American Heart... Oct 2023Background The success of cardiac auscultation varies widely among medical professionals, which can lead to missed treatments for structural heart disease. Applying...
Background The success of cardiac auscultation varies widely among medical professionals, which can lead to missed treatments for structural heart disease. Applying machine learning to cardiac auscultation could address this problem, but despite recent interest, few algorithms have been brought to clinical practice. We evaluated a novel suite of Food and Drug Administration-cleared algorithms trained via deep learning on >15 000 heart sound recordings. Methods and Results We validated the algorithms on a data set of 2375 recordings from 615 unique subjects. This data set was collected in real clinical environments using commercially available digital stethoscopes, annotated by board-certified cardiologists, and paired with echocardiograms as the gold standard. To model the algorithm in clinical practice, we compared its performance against 10 clinicians on a subset of the validation database. Our algorithm reliably detected structural murmurs with a sensitivity of 85.6% and specificity of 84.4%. When limiting the analysis to clearly audible murmurs in adults, performance improved to a sensitivity of 97.9% and specificity of 90.6%. The algorithm also reported timing within the cardiac cycle, differentiating between systolic and diastolic murmurs. Despite optimizing acoustics for the clinicians, the algorithm substantially outperformed the clinicians (average clinician accuracy, 77.9%; algorithm accuracy, 84.7%.) Conclusions The algorithms accurately identified murmurs associated with structural heart disease. Our results illustrate a marked contrast between the consistency of the algorithm and the substantial interobserver variability of clinicians. Our results suggest that adopting machine learning algorithms into clinical practice could improve the detection of structural heart disease to facilitate patient care.
Topics: Adult; Humans; Deep Learning; Heart Murmurs; Heart Diseases; Heart Auscultation; Algorithms
PubMed: 37830333
DOI: 10.1161/JAHA.123.030377 -
Annals of Medicine and Surgery (2012) Oct 2023Although clinical guidelines suggest echocardiography before surgery in patients with hip fracture, no prospective studies exist in the literature. The aim of the...
INTRODUCTION
Although clinical guidelines suggest echocardiography before surgery in patients with hip fracture, no prospective studies exist in the literature. The aim of the present investigation was to assess whether preoperative echocardiography affects time to surgery, length of hospital stay (LOS), and in hospital mortality in high-risk patients who need surgery for a hip fracture.
MATERIAL AND METHODS
In the study entered 255 consecutive patients with hip fracture referred to a multidisciplinary hip fracture unit. Seven hundred seventeen patients referred before the implementation of routine echocardiographic examination were considered as control group. Echocardiography was performed in patients with systolic murmurs, unstable clinical conditions, recent decompensation of heart failure or hospital admission for coronary disease. Time to surgery, LOS, and in hospital mortality in patients who underwent preoperative echocardiography (high-risk group) were compared with patients who did not undergo echo (low-risk group) and with the control group.
RESULTS
122/255 patients underwent echocardiography. The two groups did not differ for age, sex, type or fracture, and notably time to surgery and LOS. Coronary heart disease, atrial fibrillation, and two or more comorbidities were more frequent in the echo group. Overall clinical characteristics were not different from group of patients referred before the implementation of the echocardiographic protocol but in these last patients time to surgery and LOS were significantly longer. As well in hospital mortality was not significantly different in the two groups (1.9 in echo vs. 1.7% in nonecho) but lower than in the control group (4.1% ).
CONCLUSIONS
An echocardiographic guide may be useful in a high-risk group with a hip fracture to choose the proper anesthetic setting, referral for intensive care observation after surgery and, optimal medical treatment, including fluid management without delay in time to surgery.
PubMed: 37811064
DOI: 10.1097/MS9.0000000000001151 -
Pediatric Nephrology (Berlin, Germany) Apr 2024A 3-year-old female patient with no significant medical history presented to her pediatrician with foamy urine. Initial testing revealed moderate proteinuria on...
A 3-year-old female patient with no significant medical history presented to her pediatrician with foamy urine. Initial testing revealed moderate proteinuria on qualitative testing, although she was incidentally noted to have severe hypertension (240/200 mmHg). Physical examination of the carotid and femoral areas revealed significant systolic vascular murmurs. Labs showed elevated serum creatinine, hypokalemia, metabolic alkalosis, elevated renin and aldosterone and hypercalciuria. Echocardiography identified ventricular hypertrophy. Computed tomography (CT) of the abdomen and magnetic resonance angiography of the head showed multiple tortuous or interrupted arteries and multiple calcifications in the renal sinus area. B-mode ultrasonography suggested thickening of the carotid and femoral artery walls, with numerous spotted calcifications. Genetic testing revealed that ABCC6 had a complex heterozygous mutation (exon 24: c.3340C > T and intron 30: c.4404-1G > A). Our panel of experts reviewed the evaluation of this patient with hypertension, proteinuria, hypercalciuria, and vascular abnormalities as well as the diagnosis and appropriate management of a rare disease.
Topics: Female; Humans; Child, Preschool; Hypercalciuria; Hypertension; Hypokalemia; Genetic Testing; Proteinuria
PubMed: 38165475
DOI: 10.1007/s00467-023-06230-3 -
European Heart Journal. Case Reports Sep 2023Rheumatic heart disease is a major disease that seriously affects human health and survival worldwide. Rheumatic mitral stenosis often has relatively complex...
BACKGROUND
Rheumatic heart disease is a major disease that seriously affects human health and survival worldwide. Rheumatic mitral stenosis often has relatively complex pathological changes, and its progression leads to various manifestations of mitral valve dysfunction and adverse clinical events.
CASE SUMMARY
We present a 60-year-old patient who developed chest tightness, shortness of breath, and bilateral lower limb oedema in 2018 (New York Heart Association functional class III). Systolic and diastolic murmurs could be heard in the mitral auscultation area. In December 2021, the patient was admitted to the hospital with stroke. Thereafter, transthoracic echocardiography and computed tomography were performed, and the progress of rheumatic mitral stenosis was recorded. Due to the patient's high surgical risk, a patient-specific three-dimensional printed model was used to observe anatomical structures and simulate main procedures, and the surgeons finally chose to perform transcatheter mitral valve replacement. The balloon-expandable bioprothesis was released from the right femoral artery to treat the rheumatic mitral stenosis. The patient remained asymptomatic at the 6-month follow-up.
DISCUSSION
For patients with rheumatic mitral stenosis with high surgical risk, it is feasible to conduct transcatheter mitral valve replacement under the guidance of three-dimensional printing.
PubMed: 37718998
DOI: 10.1093/ehjcr/ytad434 -
Animals : An Open Access Journal From... Jan 2024Mitral and aortic valve insufficiencies have been commonly reported in horses. The objective of this study was to establish the use of acoustic cardiography (Audicor) in...
Mitral and aortic valve insufficiencies have been commonly reported in horses. The objective of this study was to establish the use of acoustic cardiography (Audicor) in horses with aortic (AI) or mitral valve insufficiency (MI). A total of 17 healthy horses, 18 horses with AI, and 28 horses with MI were prospectively included. None of the horses was in heart failure. Echocardiography and Audicor analyses were conducted. Electromechanical activating time (EMAT), rate-corrected EMATc, left ventricular systolic time (LVST), rate-corrected LVSTc, and intensity and persistence of the third and fourth heart sound (S3, S4) were reported by Audicor. Graphical analysis of the three-dimensional (3D) phonocardiogram served to visually detect murmurs. Audicor snapshot variables were compared between groups using one-way ANOVA followed by Tukey's multiple-comparisons test. The association between Audicor snapshot variables and the corresponding echocardiographic variables was investigated by linear regression and Bland-Altman analyses. Heart murmurs were not displayed on Audicor phonocardiograms. No significant differences were found between Audicor variables obtained in clinically healthy horses and horses with valvular insufficiency. The Audicor device is unable to detect heart murmurs in horses. Audicor variables representing cardiac function are not markedly altered, and their association with corresponding echocardiographic variables is poor in horses with valvular insufficiency that are not in heart failure.
PubMed: 38275790
DOI: 10.3390/ani14020331 -
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