-
The Keio Journal of Medicine Sep 1995Although it is not possible to distinguish the shape of a murmur as being crescendo-decrescendo as in ejection murmurs from a plateau-shaped regurgitant systolic murmur... (Comparative Study)
Comparative Study Review
Although it is not possible to distinguish the shape of a murmur as being crescendo-decrescendo as in ejection murmurs from a plateau-shaped regurgitant systolic murmur by hearing the murmur alone, it is possible to distinguish them by auscultation with the use of other characteristics that give clues to their shape or their origin. With the use of accompanying heart sounds, the peak of the crescendo-decrescendo effect of ejection murmurs makes a recognizable rhythm which is absent in the plateau-shaped regurgitant murmur. When no heart sounds are present, the increase in loudness after a sudden long diastole of only the ejection murmur can help to separate the two types of murmur. The term "midsystolic" as applied to the ejection murmur is misleading and should be avoided because it is based on controversial hemodynamics and it obstructs teaching the significance of early, mid, and late peaks to ejection murmurs.
Topics: Diagnosis, Differential; Heart Murmurs; Heart Sounds; Humans; Systole
PubMed: 7474646
DOI: 10.2302/kjm.44.85 -
Journal of the American Animal Hospital... 2000
Review
Topics: Animals; Aortic Valve Stenosis; Dog Diseases; Dogs; Heart Murmurs; Severity of Illness Index
PubMed: 10997510
DOI: 10.5326/15473317-36-5-379 -
The Journal of Veterinary Medical... Jun 2010Seven hundreds fifty-two Standardbreds, with poor performance, underwent a thorough diagnostic protocol. In 157 out of 233 horses, with cardiac murmurs, echocardiography...
Seven hundreds fifty-two Standardbreds, with poor performance, underwent a thorough diagnostic protocol. In 157 out of 233 horses, with cardiac murmurs, echocardiography and color flow Doppler (CFD) mapping were performed. Murmur of tricuspid valve regurgitation was identified in 185 horses, while murmurs of mitral (23), aortic (9) and pulmonary (3) valve regurgitations were detected less frequently. Functional systolic, functional pre-systolic, and functional early diastolic murmurs were identified in 10, 11 and 2 horses. Two-dimensional and M-mode echocardiography showed no abnormality in 145 horses and by CFD the presence of one or more jets of valve regurgitation were observed in 149 patients. The results obtained suggest that cardiac murmurs are a common finding in Standardbreds presented with poor performance.
Topics: Animals; Aortic Valve Insufficiency; Diastole; Echocardiography; Echocardiography, Doppler, Color; Heart Murmurs; Horse Diseases; Horses; Mitral Valve Insufficiency; Physical Examination; Prevalence; Running; Systole; Tricuspid Valve Insufficiency
PubMed: 20110625
DOI: 10.1292/jvms.09-0217 -
JAAPA : Official Journal of the... Mar 2002
Review
Topics: Child; Heart Defects, Congenital; Heart Murmurs; Humans; Physical Examination
PubMed: 11949542
DOI: No ID Found -
The New England Journal of Medicine Dec 1955
Topics: Heart Murmurs; Heart Sounds; Humans; Mitral Valve Stenosis
PubMed: 13272837
DOI: 10.1056/NEJM195512152532401 -
Lyon Medical Aug 1951
Topics: Anemia; Heart Murmurs; Heart Sounds; Humans; Sound
PubMed: 14874590
DOI: No ID Found -
Journal of Feline Medicine and Surgery Aug 2021The aim of this study was to define the clinical characteristics of cats referred for evaluation of subclinical cardiac murmurs, and, secondarily, to identify predictors...
OBJECTIVES
The aim of this study was to define the clinical characteristics of cats referred for evaluation of subclinical cardiac murmurs, and, secondarily, to identify predictors of echocardiographic identification of cardiac disease.
METHODS
One hundred and sixty-three apparently healthy cats with subclinical murmurs were retrospectively enrolled. Medical records of cats older than 1 year of age referred for the evaluation of subclinical murmurs were reviewed. Cats were considered healthy if clinical signs of systemic disease or cardiac disease were not reported and cats were not receiving cardiac medications. Logistic regression was used to identify clinical variables that predict echocardiographic identification of cardiac disease.
RESULTS
One hundred and eight cats (66.3%) had echocardiographic evidence of cardiac disease with hypertrophic cardiomyopathy being the most common (80.5%). Left atrial enlargement was uncommon; in 90% of cats with echocardiographically identified cardiac disease, the left atrial aortic ratio from two-dimensional echocardiography was <1.51. Cats with cardiac disease were more likely to be male ( = 0.016), weigh more ( <0.01) and have a murmur of intensity ⩾3/6 ( = 0.019) than cats without cardiac disease. Murmur intensity ⩾grade 3/6 ( = 0.01) and male sex ( = 0.01) were independent predictors of echocardiographic evidence of cardiac disease in multivariable analysis.
CONCLUSIONS AND RELEVANCE
The majority of cats referred for evaluation of subclinical cardiac murmurs have cardiac disease. Based on left atrial dimensions, cardiac disease is generally mild. Male sex and a loud cardiac murmur are associated with the identification of cardiac disease.
Topics: Animals; Cardiomyopathy, Hypertrophic; Echocardiography; Female; Heart Diseases; Heart Murmurs; Male; Retrospective Studies
PubMed: 33215949
DOI: 10.1177/1098612X20972058 -
Identifying pediatric heart murmurs and distinguishing innocent from pathologic using deep learning.Artificial Intelligence in Medicine Jul 2024To develop a deep learning algorithm to perform multi-class classification of normal pediatric heart sounds, innocent murmurs, and pathologic murmurs.
OBJECTIVE
To develop a deep learning algorithm to perform multi-class classification of normal pediatric heart sounds, innocent murmurs, and pathologic murmurs.
METHODS
We prospectively enrolled children under age 18 being evaluated by the Division of Pediatric Cardiology. Parents provided consent for a deidentified recording of their child's heart sounds with a digital stethoscope. Innocent murmurs were validated by a pediatric cardiologist and pathologic murmurs were validated by echocardiogram. To augment our collection of normal heart sounds, we utilized a public database of pediatric heart sound recordings (Oliveira, 2022). We propose two novel approaches for this audio classification task. We train a vision transformer on either Markov transition field or Gramian angular field image representations of the frequency spectrum. We benchmark our results against a ResNet-50 CNN trained on spectrogram images.
RESULTS
Our final dataset consisted of 366 normal heart sounds, 175 innocent murmurs, and 216 pathologic murmurs. Innocent murmurs collected include Still's murmur, venous hum, and flow murmurs. Pathologic murmurs included ventricular septal defect, tetralogy of Fallot, aortic regurgitation, aortic stenosis, pulmonary stenosis, mitral regurgitation and stenosis, and tricuspid regurgitation. We find that the Vision Transformer consistently outperforms the ResNet-50 on all three image representations, and that the Gramian angular field is the superior image representation for pediatric heart sounds. We calculated a one-vs-rest multi-class ROC curve for each of the three classes. Our best model achieves an area under the curve (AUC) value of 0.92 ± 0.05, 0.83 ± 0.04, and 0.88 ± 0.04 for identifying normal heart sounds, innocent murmurs, and pathologic murmurs, respectively.
CONCLUSION
We present two novel methods for pediatric heart sound classification, which outperforms the current standard of using a convolutional neural network trained on spectrogram images. To our knowledge, we are the first to demonstrate multi-class classification of pediatric murmurs. Multiclass output affords a more explainable and interpretable model, which can facilitate further model improvement in the downstream model development cycle and enhance clinician trust and therefore adoption.
Topics: Humans; Deep Learning; Heart Murmurs; Child; Child, Preschool; Infant; Adolescent; Prospective Studies; Heart Sounds; Female; Male; Algorithms; Diagnosis, Differential; Heart Auscultation
PubMed: 38723434
DOI: 10.1016/j.artmed.2024.102867 -
Annals of Internal Medicine Jul 1950
Topics: Heart; Heart Murmurs; Mitral Valve; Mitral Valve Stenosis
PubMed: 15426092
DOI: 10.7326/0003-4819-33-1-56 -
Heart, Lung & Circulation Feb 2020Innocent murmurs are common in childhood. Echocardiography may diagnose almost all congenital cardiac abnormalities. Earlier studies have suggested that it may be... (Clinical Trial)
Clinical Trial
BACKGROUND
Innocent murmurs are common in childhood. Echocardiography may diagnose almost all congenital cardiac abnormalities. Earlier studies have suggested that it may be unnecessary when a clinical diagnosis of an innocent murmur is made by an experienced cardiologist. Yet, echocardiography is commonly performed despite such a diagnosis. Is that justifiable?
METHODS
Patients referred to a paediatric cardiologist for evaluation of a murmur were assessed. If an innocent murmur was clinically diagnosed, an echocardiogram and an electrocardiogram were ordered when requested. The cardiologist completed a questionnaire documenting the reasons for the investigations and his degree of confidence in the clinical diagnosis. The parents and patients were informed of the diagnosis and the results of the investigations.
RESULTS
In almost all 62 cases whose murmurs were clinically considered to be innocent, the referring doctor expected an echocardiogram to be performed. Following echocardiography, one patient was found to have a small muscular ventricular septal defect. On review, the murmur was consistent with that diagnosis. Three (3) others had abnormal echocardiograms namely congenitally corrected transposition of great arteries, partial anomalous right upper lobe pulmonary vein, and left ventricular non-compaction. All on review were still considered clinically to have innocent murmurs.
CONCLUSIONS
Despite the competency of the cardiologist, echocardiography diagnosed important but relatively uncommon cardiac abnormalities with prognostic implications that would have been missed if only the clinical examination was performed. Over and above the referring doctor's expectations for an echocardiogram to be performed is the need for the cardiologist to provide a complete and definitive diagnosis.
Topics: Child; Child, Preschool; Echocardiography; Female; Heart Defects, Congenital; Heart Murmurs; Humans; Infant; Male; Surveys and Questionnaires
PubMed: 30876810
DOI: 10.1016/j.hlc.2019.02.003