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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 -
Pediatric Clinics of North America Oct 2020Chest pain and heart murmurs are common issues primary care providers must evaluate and manage. Both are a source of anxiety for patients, parents, and providers,... (Review)
Review
Chest pain and heart murmurs are common issues primary care providers must evaluate and manage. Both are a source of anxiety for patients, parents, and providers, necessitating evaluation and understanding to ensure appropriate management. Most pediatric chest pain can be treated symptomatically and with reassurance. This article examines the approach to pediatric chest pain including identification of key historical points, common causes of chest pain, and when to refer. The article also delineates our approach to auscultation, describes common benign murmurs, and offers suggestions on when to refer for further evaluation.
Topics: Adolescent; Chest Pain; Child; Diagnosis, Differential; Heart Murmurs; Humans; Referral and Consultation
PubMed: 32888681
DOI: 10.1016/j.pcl.2020.05.003 -
European Heart Journal. Cardiovascular... Jan 2021
Topics: Echocardiography; Heart Murmurs; Humans
PubMed: 32705134
DOI: 10.1093/ehjci/jeaa157 -
Scandinavian Journal of Primary Health... Dec 2022To investigate interrater and intrarater agreement between physicians and medical students on heart sound classification from audio recordings, and factors predicting...
OBJECTIVE
To investigate interrater and intrarater agreement between physicians and medical students on heart sound classification from audio recordings, and factors predicting agreement with a reference classification.
DESIGN
Intra- and interrater agreement study.
SUBJECTS
Seventeen GPs and eight cardiologists from Norway and the Netherlands, eight medical students from Norway.
MAIN OUTCOME MEASURES
Proportion of agreement and kappa coefficients for intrarater agreement and agreement with a reference classification.
RESULTS
The proportion of intrarater agreement on the presence of any murmur was 83% on average, with a median kappa of 0.64 (range = 0.09-0.86) for all raters, and 0.65, 0.69, and 0.61 for GPs, cardiologist, and medical students, respectively.The proportion of agreement with the reference on any murmur was 81% on average, with a median kappa of 0.67 (range 0.29-0.90) for all raters, and 0.65, 0.69, and 0.51 for GPs, cardiologists, and medical students, respectively.Distinct murmur, more than five years of clinical practice, and cardiology specialty were most strongly associated with the agreement, with ORs of 2.41 (95% CI 1.63-3.58), 2.19 (1.58-3.04), and 2.53 (1.46-4.41), respectively.
CONCLUSION
We observed fair but variable agreement with a reference on heart murmurs, and physician experience and specialty, as well as murmur intensity, were the factors most strongly associated with agreement.Key points:Heart auscultation is the main physical examination of the heart, but we lack knowledge of inter- and intrarater agreement on heart sounds.• Physicians identified heart murmurs from heart sound recordings fairly reliably compared with a reference classification, and with fair intrarater agreement.• Both intrarater agreement and agreement with the reference showed considerable variation between doctors• Murmur intensity, more than five years in clinical practice, and cardiology specialty were most strongly linked to agreement with the reference.
Topics: Humans; Heart Murmurs; Heart Auscultation; Heart Sounds; Students, Medical; Cardiology; Reproducibility of Results
PubMed: 36598178
DOI: 10.1080/02813432.2022.2159204 -
Pediatrics in Review Jul 2021
Topics: Heart Murmurs; Humans; Physical Examination
PubMed: 34210756
DOI: 10.1542/pir.2020-000604 -
The Veterinary Record Apr 2022Spontaneous week-to-week variation in the presence and intensity of innocent cardiac murmurs in individual puppies is unknown.
BACKGROUND
Spontaneous week-to-week variation in the presence and intensity of innocent cardiac murmurs in individual puppies is unknown.
METHODS
Sixty privately owned, clinically healthy Cairn terrier and Dachshund puppies between 4 and 8 weeks of age were included. All dogs underwent weekly cardiac auscultation at the breeders' home by a veterinary cardiology specialist using an acoustic stethoscope. On each occasion, a phonocardiogram was recorded with an electronic stethoscope. Furthermore, all dogs were auscultated once at a first opinion veterinary practise and once at the authors' institution, where they also underwent an echocardiographic examination.
RESULTS
Two-hundred and eighty-one auscultations were conducted on 32 Cairn terriers and 28 Dachshunds, at the breeders' homes. Innocent murmurs were detected in 19 puppies. Two of these puppies had a detectable murmur on each auscultation. In five of the puppies, the murmur became undetectable during the observation period and in 12 puppies the murmur was intermittently audible. Auscultation at the authors' institution had an unpredictable effect on murmur presence and intensity. Phonocardiography revealed murmurs in 42 puppies. Interpretation of phonocardiograms by two independent observers showed nearly perfect agreement (κ = 0.859).
CONCLUSIONS
Remarkable and unpredictable spontaneous week-to-week variation was documented in the presence and intensity of innocent murmurs.
Topics: Animals; Dogs; Echocardiography; Heart Auscultation; Heart Murmurs; Stethoscopes
PubMed: 34807995
DOI: 10.1002/vetr.1173 -
The American Journal of Emergency... Nov 2020Cardiogenic shock is difficult to diagnose due to diverse presentations, overlap with other shock states (i.e. sepsis), poorly understood pathophysiology, complex and... (Review)
Review
INTRODUCTION
Cardiogenic shock is difficult to diagnose due to diverse presentations, overlap with other shock states (i.e. sepsis), poorly understood pathophysiology, complex and multifactorial causes, and varied hemodynamic parameters. Despite advances in interventions, mortality in patients with cardiogenic shock remains high. Emergency clinicians must be ready to recognize and start appropriate therapy for cardiogenic shock early.
OBJECTIVE
This review will discuss the clinical evaluation and diagnosis of cardiogenic shock in the emergency department with a focus on the emergency clinician.
DISCUSSION
The most common cause of cardiogenic shock is a myocardial infarction, though many causes exist. It is classically diagnosed by invasive hemodynamic measures, but the diagnosis can be made in the emergency department by clinical evaluation, diagnostic studies, and ultrasound. Early recognition and stabilization improve morbidity and mortality. This review will focus on identification of cardiogenic shock through clinical examination, laboratory studies, and point-of-care ultrasound.
CONCLUSIONS
The emergency clinician should use the clinical examination, laboratory studies, electrocardiogram, and point-of-care ultrasound to aid in the identification of cardiogenic shock. Cardiogenic shock has the potential for significant morbidity and mortality if not recognized early.
Topics: Acidosis, Lactic; Bradycardia; Confusion; Early Diagnosis; Echocardiography; Edema; Electrocardiography; Emergency Service, Hospital; Heart Failure; Heart Murmurs; Humans; Hypotension; Kidney Function Tests; Lactic Acid; Liver Function Tests; Multiple Organ Failure; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Physical Examination; Point-of-Care Systems; Pulmonary Edema; Shock, Cardiogenic; Tachycardia; Troponin
PubMed: 33039227
DOI: 10.1016/j.ajem.2020.09.045 -
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 -
Current Problems in Cardiology Feb 2023A heart murmur in adults is a common reason for referral for echocardiography at most general cardiology clinics in Europe. A murmur may indicate either a mild... (Review)
Review
A heart murmur in adults is a common reason for referral for echocardiography at most general cardiology clinics in Europe. A murmur may indicate either a mild age-related valvular calcification or regurgitation, or represent a significant heart valve disease requiring valvular intervention. Generally, the correlation between murmurs by auscultation and severity of heart valve disease by echocardiography is poor. Particularly, the severity and characterization of diastolic murmurs by auscultation may poorly correlate with echocardiographic findings. This narrative review aims to summarize the differential diagnoses of physiological and pathological murmurs, describes the current referral practice of murmur patients for echocardiography, and presents a single-center experience on the correlation of auscultation and echocardiographic findings with a particular focus on aortic and mitral valve diseases. A careful auscultation of the heart prior to the echocardiogram is mandatory and may help to predict the echocardiographic findings and their interpretation in view of the clinical information. The correlation between clinical examination, point of care ultrasound and standard echocardiography is a matter of continued exploration.
Topics: Adult; Humans; Heart Auscultation; Cardiologists; Heart Murmurs; Echocardiography; Heart Valve Diseases
PubMed: 36336114
DOI: 10.1016/j.cpcardiol.2022.101479 -
Clinical and Translational Medicine Nov 2022Altered splicing landscape is an emerging cancer hallmark; however, the dysregulation and implication of the cellular machinery controlling this process (spliceosome...
INTRODUCTION
Altered splicing landscape is an emerging cancer hallmark; however, the dysregulation and implication of the cellular machinery controlling this process (spliceosome components and splicing factors) in hepatocellular carcinoma (HCC) is poorly known. This study aimed to comprehensively characterize the spliceosomal profile and explore its role in HCC.
METHODS
Expression levels of 70 selected spliceosome components and splicing factors and clinical implications were evaluated in two retrospective and six in silico HCC cohorts. Functional, molecular and mechanistic studies were implemented in three cell lines (HepG2, Hep3B and SNU-387) and preclinical Hep3B-induced xenograft tumours.
RESULTS
Spliceosomal dysregulations were consistently found in retrospective and in silico cohorts. EIF4A3, RBM3, ESRP2 and SRPK1 were the most dysregulated spliceosome elements in HCC. EIF4A3 expression was associated with decreased survival and greater recurrence. Plasma EIF4A3 levels were significantly elevated in HCC patients. In vitro EIF4A3-silencing (or pharmacological inhibition) resulted in reduced aggressiveness, and hindered xenograft-tumours growth in vivo, whereas EIF4A3 overexpression increased tumour aggressiveness. EIF4A3-silencing altered the expression and splicing of key HCC-related genes, specially FGFR4. EIF4A3-silencing blocked the cellular response to the natural ligand of FGFR4, FGF19. Functional consequences of EIF4A3-silencing were mediated by FGFR4 splicing as the restoration of non-spliced FGFR4 full-length version blunted these effects, and FGFR4 inhibition did not exert further effects in EIF4A3-silenced cells.
CONCLUSIONS
Splicing machinery is strongly dysregulated in HCC, providing a source of new diagnostic, prognostic and therapeutic options in HCC. EIF4A3 is consistently elevated in HCC patients and associated with tumour aggressiveness and mortality, through the modulation of FGFR4 splicing.
Topics: Humans; Spliceosomes; Carcinoma, Hepatocellular; Retrospective Studies; Liver Neoplasms; Oncogenes; RNA Splicing Factors; Heart Murmurs; Protein Serine-Threonine Kinases; RNA-Binding Proteins; Eukaryotic Initiation Factor-4A; DEAD-box RNA Helicases
PubMed: 36419260
DOI: 10.1002/ctm2.1102