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Veterinary Research Forum : An... 2022A one and a half years old male French bulldog weighing 9.50 kg was presented with the history of inappetence, lethargy, abdominal distension and exercise intolerance...
A one and a half years old male French bulldog weighing 9.50 kg was presented with the history of inappetence, lethargy, abdominal distension and exercise intolerance since last 2 days. The physical examination was done which revealed normal physiological parameters including temperature, mucus membrane color and capillary refill time except palpable precordial thrills, jugular distension on palpation, tachycardia and systolic murmurs on auscultation. Electrocardiography (ECG) was done which depicted ectopic foci with atrioventricular junctional tachycardia and right ventricular enlargement involving very small inverted P waves, deep S waves in leads I, II, III and augmented vector foot (aVF) and splintered QRS complexes. The dog was undergone chest radiography that revealed right atrial enlargement, increased sternal contact of heart on lateral view and a bulge at 9:00 o'clock to 11:00 o'clock depicted right atrial enlargement on dorso-ventral view. Lastly, echocardiography was done to arrive at a diagnosis confirming the Ebstein's anomaly as a form of tricuspid valve dysplasia including apical displacement of tricuspid valve leaflets, division of right ventricle into atrialized and functional portions, increased displacement index, increased apex-mitral annulus to apex-tricuspid annulus ratio, severe right atrial dilatation and tricuspid regurgitation. The dog was medically treated with diuretics, angiotensin converting enzyme inhibitors and inotropes and the owner was advised to put the dog on low sodium diet for 2 weeks. The dog has resolved clinical signs of right sided heart affection; but, suddenly collapsed at home. The owner denied for the necropsy of dog.
PubMed: 36686865
DOI: 10.30466/vrf.2022.550981.3425 -
Journal of the American Heart... May 2021Background Clinicians vary markedly in their ability to detect murmurs during cardiac auscultation and identify the underlying pathological features. Deep learning...
Background Clinicians vary markedly in their ability to detect murmurs during cardiac auscultation and identify the underlying pathological features. Deep learning approaches have shown promise in medicine by transforming collected data into clinically significant information. The objective of this research is to assess the performance of a deep learning algorithm to detect murmurs and clinically significant valvular heart disease using recordings from a commercial digital stethoscope platform. Methods and Results Using >34 hours of previously acquired and annotated heart sound recordings, we trained a deep neural network to detect murmurs. To test the algorithm, we enrolled 962 patients in a clinical study and collected recordings at the 4 primary auscultation locations. Ground truth was established using patient echocardiograms and annotations by 3 expert cardiologists. Algorithm performance for detecting murmurs has sensitivity and specificity of 76.3% and 91.4%, respectively. By omitting softer murmurs, those with grade 1 intensity, sensitivity increased to 90.0%. Application of the algorithm at the appropriate anatomic auscultation location detected moderate-to-severe or greater aortic stenosis, with sensitivity of 93.2% and specificity of 86.0%, and moderate-to-severe or greater mitral regurgitation, with sensitivity of 66.2% and specificity of 94.6%. Conclusions The deep learning algorithm's ability to detect murmurs and clinically significant aortic stenosis and mitral regurgitation is comparable to expert cardiologists based on the annotated subset of our database. The findings suggest that such algorithms would have utility as front-line clinical support tools to aid clinicians in screening for cardiac murmurs caused by valvular heart disease. Registration URL: https://clinicaltrials.gov; Unique Identifier: NCT03458806.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Cross-Sectional Studies; Deep Learning; Diagnosis, Computer-Assisted; Equipment Design; Female; Heart Auscultation; Heart Murmurs; Humans; Male; Middle Aged; Reproducibility of Results; Stethoscopes; Young Adult
PubMed: 33899504
DOI: 10.1161/JAHA.120.019905 -
Blood Pressure Monitoring Feb 2022Innocent heart murmur is common in healthy infants, children and adolescents. Although most cases are not pathologic, a murmur may be the manifestation of cardiovascular...
BACKGROUND
Innocent heart murmur is common in healthy infants, children and adolescents. Although most cases are not pathologic, a murmur may be the manifestation of cardiovascular disease. It may also cause or be an indicator of blood pressure (BP) and heart rate (HR) changes.
OBJECTIVE
This study aimed to document changes in BP and HR in children with Still's vibratory murmur (SVM).
METHODS
This study included 226 children with SVM, and the control group included 138 healthy children that were age-, height- and weight-balanced. Patient files and our hospital registry system were retrospectively investigated for laboratory findings and electrocardiography and echocardiography results. In addition, we prospectively performed 24-h ambulatory BP monitoring in both groups.
RESULTS
There were no statistically significant differences in 24-h, daytime and nighttime systolic BP, 24-h and nighttime diastolic BP and nighttime HR between the patient and control groups (P = ns). However, daytime diastolic BP, mean HR and daytime HR were significantly higher in patient group (P = 0.009, 0.039 and 0007, respectively).
CONCLUSIONS
We believe that in the presence of a higher HR and a higher aortic diastolic BP, which may induce hemodynamic changes in the left ventricle, flow turbulence through the aortic valve may increase, increasing the probability of hearing a murmur. ambulatory BP monitoring could be useful to obtain a better picture of these parameters during the 24-h period.
Topics: Adolescent; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Child; Circadian Rhythm; Heart Murmurs; Heart Rate; Humans; Hypertension; Retrospective Studies
PubMed: 34992203
DOI: 10.1097/MBP.0000000000000557 -
BioMed Research International 2022Most researchers use features of diastolic murmurs to identify coronary artery disease. However, the diastolic murmurs of coronary artery disease are usually very weak...
Most researchers use features of diastolic murmurs to identify coronary artery disease. However, the diastolic murmurs of coronary artery disease are usually very weak and are easily contaminated by noise and valvular murmurs. Therefore, the diagnostic accuracy of coronary artery disease when only using diastolic murmurs is not well. An algorithm for improving the accuracy in the identification of coronary artery disease by combining the features of the first heart sound and diastolic murmurs was proposed. Firstly, a first heart sound feature extraction algorithm was used to identify coronary artery disease from noncoronary artery disease. Secondly, the Empirical Wavelet Transform algorithm was used to decompose the diastolic heart sound into three modes, and the spectral energy of each mode was calculated to distinguish coronary artery disease from noncoronary artery disease. Then, the features of the fist heart sound, the second diastolic spectral energy, and the parameter P3, which was used to discriminate the diastolic murmurs in coronary artery disease and in valvular disease, were combined together to improve the diagnostic accuracy of coronary artery disease. The comparison experiment results show that the accuracy of the proposed algorithm is superior to some state-of-the-art methods when they are used to diagnose coronary artery disease.
Topics: Algorithms; Coronary Artery Disease; Heart Murmurs; Heart Sounds; Humans; Wavelet Analysis
PubMed: 35252442
DOI: 10.1155/2022/3058835 -
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 -
Technology and Culture 2022This article reviews twenty-six volumes of History of Science and Technology in China, a collaborative scholarly work published from 1998 to 2011. The review focuses on... (Review)
Review
This article reviews twenty-six volumes of History of Science and Technology in China, a collaborative scholarly work published from 1998 to 2011. The review focuses on the volumes dealing with the history of technology: Mining and Metallurgy, Machinery, and Transportation. Clearly the series has impacted Chinese literature on the history of technology in China, being the first work to comprehensively and systematically study and expound the history of science and technology in ancient China from the perspective of Chinese scholars.
Topics: Humans; Technology; Publications; China; Transportation; Heart Murmurs
PubMed: 36341613
DOI: 10.1353/tech.2022.0163 -
Veterinary Research Forum : An... Sep 2022Heart murmurs and valvular regurgitation are common in horses and often have no effect on their performance. However, when structural changes occur in the heart size,...
Heart murmurs and valvular regurgitation are common in horses and often have no effect on their performance. However, when structural changes occur in the heart size, they can affect performance adversely. This study aimed to examine the correlation between cardiac valves disease and poor performance in athletic horses. A total of 300 athletic Thoroughbred and mix-breed horses including 164 mares and 136 stallions, with a history of poor performance, were selected. Horses with cardiac murmurs were identified and further cardiac examination including precise auscultation, base-apex electrocardiogram for possible dysrhythmias at rest and after exercise, echocardiographic and hematological tests were conducted in two stages. The first was at admission time and the second examination was done four to six months later to evaluate the outcome of the possible disorders. Respiratory system and musculoskeletal diseases were diagnosed respectively in 93 and 149 out of 300 examined horses and 36 horses showed heart murmur without any other complications. Echocardiography was performed in horses with heart murmur and 25 of them showed regurgitation of the cardiac valve. During the first examination, 7 horses were diagnosed with regurgitation and changes in the size of cardiac chambers, whereas this number increased to 25 during the second examination. There was no significant relationship between degree of murmur and severity of regurgitant jet in horses. The valvular regurgitation can affect the performance when causing changes in the size of the cardiac chambers which can consequently jeopardize the athletic future of the horse.
PubMed: 36320295
DOI: 10.30466/vrf.2021.130366.2997 -
Journal of Cardiovascular Computed... 2022Computed tomography (CT) imaging is the standard of care before transcatheter aortic valve replacement (TAVR). The aortic annulus undergoes conformational changes during...
BACKGROUND
Computed tomography (CT) imaging is the standard of care before transcatheter aortic valve replacement (TAVR). The aortic annulus undergoes conformational changes during the heart cycle. Therefore, the image acquisition time point can impact prosthesis sizing and fit. Clinical outcome data are lacking. The aim of this study was to compare systolic and diastolic cardiac CT data acquisition with regard to procedural and clinical outcomes in patients undergoing TAVR for severe aortic stenosis (AS).
METHODS
Preprocedural high-pitch helical CT datasets were analyzed in 1954 patients undergoing TAVR between 2013 and 2018 at our center. Patients were stratified into two groups according to the acquisition heart phase (979 systolic and 975 diastolic). The study was approved by the local ethics committee.
RESULTS
Median age was 81.6 [interquartile range 77.5-85.8] years and 964 (49.3%) patients were male. No significant difference was found for the Valve Academic Research Consortium-3 (VARC-3) endpoints of technical failure (systolic, 5.1% vs. diastolic, 5.2%, p = 0.94) or device failure (systolic, 13.7% vs. diastolic, 13.5%, p = 0.92). There was no difference in paravalvular regurgitation. All-cause 30-day mortality was comparable (systolic, 3.6% [95% confidence interval, 2.4-4.7%] vs. diastolic, 3.6% [2.4-4.8%], p = 1.00), while 3-year mortality rates were higher in the diastolic group (Society of Thoracic Surgeons score adjusted hazard ratio, 1.25 [1.07-1.46], p < 0.01).
CONCLUSIONS
While the 30-day technical and clinical outcomes after TAVR are comparable between systolic and diastolic CT imaging, diastolic imaging was associated with higher long-term mortality. Therefore, the data support the guideline recommendation of systolic imaging.
Topics: Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Female; Heart Murmurs; Heart Valve Prosthesis; Humans; Male; Predictive Value of Tests; Risk Factors; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35637128
DOI: 10.1016/j.jcct.2022.05.003 -
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 -
Journal of Veterinary Medical Education Feb 2023Veterinary students often struggle to correctly interpret heart sounds. This study sought to evaluate if additional online training using digital phonocardiograms...
Veterinary students often struggle to correctly interpret heart sounds. This study sought to evaluate if additional online training using digital phonocardiograms (DPCGs) improves students' ability to identify normal and pathologic heart sounds in dogs. Thirty-six randomly assigned veterinary students listened to and interpreted 10 audio recordings of normal heart sounds (2), heart murmurs (4), and arrhythmias (4) at the start and the end of a 4-week period. Twenty-two students participated in training with DPCGs, including those created from these recordings during this period, via a self-study website ( = 12) or online webinar ( = 10). Their results were compared with those of a control group ( = 14) that did not undergo additional training. Although pre- and post-training test scores did not differ between groups, both training groups showed within-group improvement between the two tests ( = .024, = .037); the control group did not ( = .49). Although neither training group showed differences in ability to differentiate normal heart sounds from arrhythmias, both showed increased ability to detect and specify heart murmurs and provide refined diagnoses of detected arrhythmias. These results suggest additional training, even without actual patients, improves students' ability to identify heart murmurs and provide specific diagnoses for arrhythmias. Further study with a larger sample size and an additional group without DPCG-based training would help evaluate the effectiveness of DPCGs regarding arrhythmias. Studying a larger sample size would also allow for a training group participating in both training methods, measuring cumulative effectiveness of both methods.
Topics: Animals; Dogs; Clinical Competence; Education, Veterinary; Heart Auscultation; Heart Murmurs; Heart Sounds; Teaching
PubMed: 35100100
DOI: 10.3138/jvme-2021-0097