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Micromachines Dec 2022In light of a need for low-frequency, high sensitivity and broadband cardiac murmur signal detection, the present work puts forward an integrated MEMS-based heart sound...
In light of a need for low-frequency, high sensitivity and broadband cardiac murmur signal detection, the present work puts forward an integrated MEMS-based heart sound sensor with a hollow concave ciliary micro-structure. The advantages of a hollow MEMS structure, in contrast to planar ciliated micro-structures, are that it reduces the ciliated mass and enhances the operating bandwidth. Meanwhile, the area of acoustic-wave reception is enlarged by the concave architecture, thereby enhancing the sensitivity at low frequencies. By rationally designing the acoustic encapsulation, the loss of heart acoustic distortion and weak cardiac murmurs is reduced. As demonstrated by experimentation, the proposed hollow MEMS structure cardiac sound sensor has a sensitivity of up to -206.9 dB at 200 Hz, showing 6.5 dB and 170 Hz increases in the sensitivity and operating bandwidth, respectively, in contrast to the planar ciliated MEMS sensor. The SNR of the sensor is 26.471 dB, showing good detectability for cardiac sounds.
PubMed: 36557472
DOI: 10.3390/mi13122174 -
BMC Cardiovascular Disorders Mar 2023Rheumatic Heart Disease (RHD) continues to cause suffering and premature deaths in many sub-Saharan Africa (SSA) countries, where the disease is still endemic. RHD is...
BACKGROUND
Rheumatic Heart Disease (RHD) continues to cause suffering and premature deaths in many sub-Saharan Africa (SSA) countries, where the disease is still endemic. RHD is largely preventable and determining its community burden is an important critical step in any RHD prevention program.
METHODS
We conducted a cross-sectional study of 5-16 years old pupils from 11 primary schools participating in an RHD prevention program in 4 districts in Tanzania, between 2018 and 2019. At the school, all children were invited to participate after receiving consent from their parents/guardians. Participating children filled a questionnaire and were auscultated for cardiac murmurs. Echocardiographic screening was done by two experienced cardiologists, using a hand-held machine (V-Scan, GE®). All positive screening tests were stored for further examination by the same two cardiologists to reach to a consensus of definite, borderline or no RHD, using a modified World Heart Federation (WHF) criterion.
RESULTS
Of the 6895 children invited, 4738 (68.7%) were screened and 4436 (64.3%) had complete data. The mean (SD) age was 10.04 (2.43) years, and 2422 (54.6%) were girls. Fifty three (1.2%) children were found to have a murmur. The proportion of children with trace or mild valvular regurgitation, sub-valvular/chordal thickening and valvular thickening/deformity were 8.3%, 1.3%, and 1.0%, respectively. Sub-clinical RHD was found in 95 children (59 definite and 36 borderline), giving a prevalence of 2.1%, [95% CI 1.7% - 2.6%]. Sub-clinical RHD was independently associated with female sex (aOR 1.83, 95% CI 1.18-2.85, p = 0.007), older age groups (aOR 1.73, 95% CI 1.10-2.72, p = 0.018 for age group 11-14 years; and aOR 3.02 95% CI 1.01-9.05, p = 0.048 for age group 15-16 years), as well as presence of a cardiac murmur, aOR 5.63 95% CI 2.31-13.69, p < 0.0001. None of the studied socio- or economic factors was associated with the presence of sub-clinical RHD in this study.
CONCLUSION
The prevalence of sub-clinical RHD among primary school children in Tanzania is 2.1%, similar to previous reports in SSA. Efforts to prevent and control RHD in our communities are highly warranted.
Topics: Humans; Child; Female; Aged; Adolescent; Child, Preschool; Male; Rheumatic Heart Disease; Cross-Sectional Studies; Tanzania; Mass Screening; Echocardiography; Prevalence; Heart Defects, Congenital
PubMed: 36966309
DOI: 10.1186/s12872-023-03186-y -
Scandinavian Journal of Clinical and... Nov 2023Systolic murmur suggestive of aortic valve origin is a common accidental finding, particularly in the elderly. Usually, it is due to aortic stenosis (AS) or aortic...
BACKGROUND
Systolic murmur suggestive of aortic valve origin is a common accidental finding, particularly in the elderly. Usually, it is due to aortic stenosis (AS) or aortic sclerosis (ASc). Currently, echocardiography is used to differentiate AS from ASc. Plasma N-terminal (NT)-prohormone BNP (NT-proBNP) is known to correlate with the severity of AS. We assessed whether NT-proBNP separates AS from ASc.
METHODS
The study population consisted of three groups: AS ( = 87, age 77 ± 7 years), ASc ( = 76, age 72 ± 10 years), and healthy controls ( = 101, age 55 ± 10 years). All subjects underwent transthoracic echocardiography and measurement of plasma NT-proBNP. Patients with diseases known to increase NT-proBNP were excluded.
RESULTS
The crude plasma NT-proBNP (median; IQR) in AS patients (413; 165-1055 ng/l) was significantly higher compared to ASc patients (96; 53-237 ng/l, < 0.001) and healthy controls (50; 29-76 ng/l, < 0.001). After adjusting for the confounding factors (age, coronary artery disease, renal function and diastolic blood pressure), plasma NT-proBNP remained significantly higher in AS patients as compared to ASc ( < 0.002) and controls ( < 0.0001). In the receiver-operating characteristic curve for NT-proBNP to identify AS from ASc and controls, the area under the curve was 0.878 with optimal cutoff of 115 ng/l. In addition, using 115 ng/l to separate AS from ASc yielded sensitivity of 0.885, and negative predictive value of 0.808.
CONCLUSIONS
NT-proBNP was sensitive to identify AS and useful to rule out AS in patients with systolic murmur in the left ventricular outflow tract provided the patient does not have coexisting disease known to impact NT-proBNP.
Topics: Humans; Aged; Aged, 80 and over; Middle Aged; Natriuretic Peptide, Brain; Systolic Murmurs; Aortic Valve Stenosis; Peptide Fragments; Biomarkers
PubMed: 37933910
DOI: 10.1080/00365513.2023.2275290 -
Journal of the American Veterinary... Nov 2023
Topics: Animals; Heart Murmurs; Echocardiography
PubMed: 37495228
DOI: 10.2460/javma.23.06.0333 -
Heart (British Cardiac Society) Jan 2020Clinical introductionA man in his 60s with no medical history presented with sudden-onset, severe interscapular pain. He was in circulatory shock with a blood pressure...
Clinical introductionA man in his 60s with no medical history presented with sudden-onset, severe interscapular pain. He was in circulatory shock with a blood pressure of 65/30 mm Hg, heart rate of 115 beats per minute, respiratory rate of 32 breaths per minute and a room air oxygen saturation of 89%. Examination demonstrated weak peripheral pulses, an elevated jugular venous pressure, faint dual heart sounds, no cardiac murmurs and bilateral lung crepitations. An ECG was recorded which showed a broad QRS (figure 1A). There were no previous ECGs to compare this with. In view of his presentation with acute-onset interscapular pain, CT of the aorta was organised by the emergency department clinicians (figure 1B-D). After the CT result was obtained, the on-call cardiologist was contacted and a bedside echocardiogram performed. This demonstrated severe left ventricular systolic dysfunction with akinesia of the apex and lateral walls. The patient was then transferred to the catheter laboratory for an emergency invasive coronary angiogram.heartjnl;106/2/126/F1F1F1Figure 1ECG and CT images at presentation (A) 12 lead ECG. (B) Contrast enhanced CT aorta - coronal view. (C) Contrast enhanced CT aorta - axial view. (D) CT aorta showing 4 chamber view of the heart. WHAT IS THE MOST LIKELY DIAGNOSIS?: Pulmonary embolism.Aortic dissection.Acute myocardial infarction.Cardiac tamponade.
Topics: Acute Pain; Aortography; Computed Tomography Angiography; Coronary Angiography; Humans; Male; Myocardial Infarction; Predictive Value of Tests; Scapula
PubMed: 31874903
DOI: 10.1136/heartjnl-2019-315821 -
BMC Medical Education Jul 2022Well performed clinical communication is a cornerstone of collaborative care in medicine but may be confounded by inconsistent intentions of the messenger and biased...
BACKGROUND
Well performed clinical communication is a cornerstone of collaborative care in medicine but may be confounded by inconsistent intentions of the messenger and biased interpretation by the recipient. A comparison of the findings of electronic echocardiography reports with clinician-completed standardised request forms provided an opportunity to assess communication quality.
AIM
The study aimed to determine clinician aptitude to complete written echocardiography referral forms by assessing the completeness, appropriateness, accuracy, and coherency of the reported clinical findings, conclusions and requests made on the referral forms. The study explored factors that may influence the quality of communication through this referral medium.
METHODS
A retrospective cohort study was conducted on patients who underwent trans-thoracic echocardiography imaging at Cecilia Makiwane Hospital in East London over 26 months. Paper echocardiography request forms that recorded the requesting clinician's findings on examination, the provisional clinical diagnosis, and the specific echocardiographic information sought, were compared with the actual findings on echocardiography.
RESULTS
Of 613 request forms reviewed, 97 cases were excluded due to illegibility or because they lacked analysable information or requester details, leaving 516 forms suitable for study. No pathology was found on echocardiography in 31%. Of the murmurs expected from the echocardiography findings, only half were recorded on the request form (sensitivity and positive predictive value both 52%.). Only 35% of request forms that mentioned a mitral systolic murmur gave a working diagnosis of mitral regurgitation and only 38% of request forms that mentioned an aortic systolic murmur considered aortic stenosis. Clinically suspected cardiomyopathy (CMO) had a PPV of 43% and echocardiographic CMO was missed clinically in 41%. Apex beat displacement reported clinically was not associated with echocardiographic LV dilatation in 65% of cases. One-third (34%) of forms reporting murmurs did not request valve function assessment and 17% considering cardiomyopathy did not request left ventricular function assessment.
CONCLUSION
Echocardiography request forms highlight vulnerabilities in clinical communication. Specifically, important clinical features were missing and more concerningly, included when unlikely to be present. There was a lack of concordance between recorded clinical findings and postulated diagnoses. Clinicians sometimes appeared unclear about the value or appropriateness of the requested assistance. Greater emphasis on teaching examination and communication skills may foster safer and more efficient use of scarce resources.
Topics: Cardiomyopathies; Communication; Echocardiography; Heart Murmurs; Humans; Referral and Consultation; Retrospective Studies; Systolic Murmurs
PubMed: 35831886
DOI: 10.1186/s12909-022-03602-5 -
Journal of Feline Medicine and Surgery Apr 2021Assessment of heart size in kittens is important, and there is a need for reference intervals (RIs) to prevent misinterpretation of cardiomegaly in this patient...
OBJECTIVES
Assessment of heart size in kittens is important, and there is a need for reference intervals (RIs) to prevent misinterpretation of cardiomegaly in this patient population. The purpose of this study was to generate RIs for echocardiographic and radiographic quantification of cardiac size in healthy kittens.
METHODS
In total, 88 kittens aged 6-16 weeks were enrolled in this study. Physical examination, and radiographic and echocardiographic evaluations were performed without sedation. Thoracic radiographs and echocardiographic images were measured to establish RIs for vertebral heart score (VHS), cardiac thoracic ratio (CTR) and multiple echocardiographic variables. N-terminal pro B-type natriuretic peptide (NT-proBNP) was measured. Statistical correlations between echocardiographic parameters and age, body weight and sex were all evaluated and RIs were generated.
RESULTS
Low-grade heart murmurs were appreciated in 26/88 kittens (29.5%). Kittens had a median VHS of 9.5 vertebrae (95% RI 8.0-10.9) and a median CTR of 67.2% (95% RI 54.4-79.8%). Measured NT-proBNP levels were comparable to healthy adult cats with a median of 31 pmol/l (upper reference limit 75 pmol/l). Multiple moderate-to-strong correlations between body weight and age with various echocardiographic parameters were observed and allometric scaling was performed for body weight. RIs for echocardiographic parameters were generated based on patient weight using allometric scaling formulas. Tricuspid valve regurgitation was a common finding and was present in 37.5% (n = 33) of the kittens.
CONCLUSIONS AND RELEVANCE
This study establishes RIs for thoracic radiograph assessment, echocardiography and cardiac biomarkers in kittens, which fills a critical gap in the veterinary literature. The VHS reported in this study is higher than previously reported for adult cats.
Topics: Animals; Biomarkers; Cats; Echocardiography; Female; Heart Murmurs; Natriuretic Peptide, Brain; Peptide Fragments; Reference Values
PubMed: 32812464
DOI: 10.1177/1098612X20946461 -
Journal of Veterinary Internal Medicine May 2021The origin of cough in dogs with heart murmurs is controversial, because the cough could be primary cardiac (eg, pulmonary edema, bronchi compression by left-sided...
BACKGROUND
The origin of cough in dogs with heart murmurs is controversial, because the cough could be primary cardiac (eg, pulmonary edema, bronchi compression by left-sided cardiomegaly) or respiratory (eg, bronchomalacia, other bronchial or bronchiolar disease, interstitial lung disease) in origin.
HYPOTHESIS/OBJECTIVES
To study the association between left atrium (LA) dilatation and cardiomegaly and bronchial narrowing in coughing dogs with heart murmurs using computed tomography (CT).
ANIMALS
Twenty-one client-owned coughing dogs with heart murmurs and 14 historical control dogs.
METHODS
Dogs with cough and murmur were prospectively recruited over 4 months. Cervical and thoracic radiography, echocardiography, and thoracic CT were performed in enrolled dogs. Control dogs, with no disease on thoracic CT and no records of heart murmur and coughing, were gathered from the institution's computerized database. Degree of bronchial narrowing was assessed using the bronchial-to-aorta (Ao) ratio, measured by 3 radiologists blinded to the clinical findings. After identifying bronchi that were significantly narrowed in dogs with murmur compared to controls, the relationship between degree of narrowing and LA/Ao ratio (measured echocardiographically) and vertebral heart scale (VHS) measured radiographically was studied in dogs with murmur using mixed-effects regression.
RESULT
Significant narrowing was identified for all left-sided bronchi and the right principal, middle, and caudal bronchi in the coughing dogs, compared with controls. Increasing LA size and VHS were significantly inversely associated with diameter for all left-sided and right-sided bronchi indicated above.
CONCLUSION AND CLINICAL IMPORTANCE
Results indicate an association between LA enlargement and cardiomegaly and bronchial narrowing and support heart size-associated exacerbation of cough in dogs with murmurs.
Topics: Animals; Bronchi; Cough; Dog Diseases; Dogs; Heart Murmurs; Tomography, X-Ray Computed
PubMed: 33811698
DOI: 10.1111/jvim.16115 -
Therapeutische Umschau. Revue... 2020A heart murmur - a frequent incidental finding Heart murmurs are very common and are present in up to 80 % of school children and 52 % of adults. They originate from...
A heart murmur - a frequent incidental finding Heart murmurs are very common and are present in up to 80 % of school children and 52 % of adults. They originate from the transition from laminar to turbulent blood flow in patients with a structural cardiomyopathy (so-called "organic" murmurs) or in patients with normal hearts (so-called "innocent" murmurs). A detailed history and physical examination help to discriminate innocent from organic murmurs. With the wide availability of transthoracic echocardiography (TTE) cardiac auscultation has lost a lot of its importance, although it remains an important skill for the initial evaluation and triage. An innocent murmur is a minor (1 / 6 - 2 / 6), crescendo-decrescendo, mostly position-dependent, mid-systolic murmur without radiation, which needs no further workup in asymptomatic patients with normal physical capacity. A TTE should be ordered if signs for a cardiac disease are present based on history, physical examination or other tests. Diastolic and continuous murmurs are mostly pathologic and warrant further workup.
Topics: Adult; Child; Echocardiography; Heart Auscultation; Heart Murmurs; Humans; Incidental Findings; Physical Examination
PubMed: 33054648
DOI: 10.1024/0040-5930/a001203 -
Postgraduate Medicine May 2024This study aimed to assess physicians' approach to cardiac murmurs and their level of knowledge about this sign, which is a crucial finding in childhood cardiac...
OBJECTIVE
This study aimed to assess physicians' approach to cardiac murmurs and their level of knowledge about this sign, which is a crucial finding in childhood cardiac anomalies.
METHODS
The study intended to include all family physicians in the Adıyaman province of Turkey, but ultimately 150 out of 210 physicians participated and was completed with a percentage response rate of 71%. Participants were asked about their approach to cardiac murmurs, answered knowledge questions, and completed a questionnaire on demographic characteristics. Subsequently, eight heart sounds were played, and participants were asked to identify the nature of each sound.
RESULTS
Family medicine specialists (all scores were < 0.001) and physicians who completed a pediatric internship lasting over a month (knowledge score = 0.012, behavioral score = 0.021, recording score = 0.01) demonstrated significantly higher knowledge, approach, and recording scores. Age and years in the profession showed a negative correlation with recording scores.
CONCLUSIONS
The study highlights the significant impact of various factors such as gender, specialization, internship duration, experience, and theoretical knowledge on the ability to recognize and approach cardiac murmurs. These findings underscore the importance of incorporating these factors into medical education and development programs, especially those aimed at improving cardiac examination skills.
Topics: Humans; Male; Female; Heart Murmurs; Clinical Competence; Turkey; Adult; Surveys and Questionnaires; Child; Middle Aged; Health Knowledge, Attitudes, Practice
PubMed: 38805321
DOI: 10.1080/00325481.2024.2360387