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Cureus Dec 2023Morgagni hernia is a rare congenital defect of the diaphragm, especially seen in children but rarely observed in adults. It occurs due to a congenital defect during the...
Morgagni hernia is a rare congenital defect of the diaphragm, especially seen in children but rarely observed in adults. It occurs due to a congenital defect during the development of the diaphragm. Bochdalek hernia is a common congenital form of diaphragmatic hernia. Morgagni hernia is usually rare with a prevalence of approximately 2-3%. Beaver tail liver, which is also called sliver of liver, is a rare variant of liver morphology. Sometimes elongated left lobe of the liver can extend laterally across the midline to contact and often surround the spleen. A 46-year-old female from Karnataka complained of fever with chills and lower back aches for seven days with no history of chest pain, vomiting, or diarrhea. There have been no similar complaints in the past. She had no other comorbidities. She was a non-smoker and non-alcoholic. Biomass gas exposure for 20 years was noted as she cooked food with firewood. She was a housewife by occupation with no history of trauma or surgeries in the past. The general physical exam was unremarkable. The respiratory system was normal. Auscultation showed decreased breath sounds in the mammary area of the right side of the chest with normal vesicular breath sounds in all other areas. Per abdominal exam showed a flat abdomen. Umbilicus was central in position. There was tenderness in the right hypochondriac and epigastric regions with no guarding or rigidity. On examining the cardiovascular system, apical impulses could not be palpated and normal heart sounds were heard with no cardiac murmurs. Other systems examination was normal. Routine blood investigations were done, revealing hemoglobin of 11.6%, total WBC of 6270 cells, and hematocrit of 33.1%. The renal function test was within normal limits (creatinine = 0.7 mg/dl). A chest X-ray revealed a right lower zone, para cardiac well-circumscribed structure suggestive of a cyst with an air-fluid level inside. Chest CT was suggestive of a hernia in the anterior aspect of the diaphragm measuring 3.5 x 3.3 cm at the level of D9 vertebral body with transverse colon and omentum as its contents, ascending upwards into anterior and superior mediastinum for a length of 13 cm causing shift of cardia posteriorly and to the left (anterior midline diaphragmatic hernia - Morgagni hernia). A hyperdense lesion (Hounsfield unit = 64) measuring 1.3 x 1.8 cm was noted in segment seven of the right lobe of the liver, suggestive of a complex cyst. Beaver tail was noted in the liver. Morgagni hernia usually presents in younger age groups with respiratory symptoms. Its incidental detection in adults is very rare. In this case, the patient was having lower backache and no other gastrointestinal symptoms. The respiratory and cardiothoracic systems get affected because the intestinal contents herniating through the diaphragm shift the position of the cardia and the lower lobes of the lungs, which may have implications such as repeated cough and infections. Symptomatic hernias are usually detected in an early age group. It can present with symptoms of gastrointestinal obstruction or acute chest symptoms or can even be asymptomatic. Treatment is primarily surgical repair of the hernia. This can be done either transthoracically or transabdominally. It is usually advised that surgical repair should be done even in asymptomatic cases as in this case, to avoid obstruction of the intestine or worsening of the hernia that is pulling the abdominal contents into the thorax.
PubMed: 38161555
DOI: 10.7759/cureus.49769 -
American Journal of Veterinary Research Jan 2024To develop breed-specific echocardiographic values for normal Borzoi and to report the prevalence of structural cardiac abnormalities.
OBJECTIVE
To develop breed-specific echocardiographic values for normal Borzoi and to report the prevalence of structural cardiac abnormalities.
ANIMALS
146 clinically healthy, adult Borzoi dogs.
METHODS
Cardiac auscultation and standard echocardiograms were performed. Longitudinal follow-up was described in a subset of dogs (n = 25).
RESULTS
Most Borzoi were structurally normal (119/146, 81.5%), with breed-specific echocardiographic values generated independently for each sex, as females weighed significantly less than males (30.4 ± 3.8 kg vs 38.3 ± 4.1 kg, respectively; P < .001), and a significant impact of sex was found on most measurements. Physiologic heart murmurs were identified in 64/119 (53.8%) normal dogs. Thirty-six (30.2%) structurally normal dogs had trace or mild mitral regurgitation, and 43 (36.1%) had trace or mild tricuspid regurgitation. Structural cardiac disease was identified in 21 dogs (14.4%), including 9 dogs (6.2%) with dilated cardiomyopathy (DCM), 9 dogs (6.2%) with stage B1 myxomatous mitral valve disease (MMVD), and 3 (2.1%) dogs with congenital abnormalities. Seven dogs (4.8%) had equivocal abnormalities. During follow-up, new dogs were diagnosed with occult DCM (n = 3), equivocal DCM (1), and stage B1 MMVD (2). Two dogs originally diagnosed with DCM (1 occult and 1 equivocal) normalized after diet change.
CLINICAL RELEVANCE
Borzoi dogs commonly have physiologic heart murmurs and mild atrioventricular valve regurgitation. Both DCM and MMVD were identified at similar frequencies in healthy Borzoi, although dogs with MMVD all had normal heart sizes. Echocardiographic screening for DCM in Borzoi should be considered, with breed-specific echocardiographic values now available for improved diagnostic confidence.
PubMed: 38154250
DOI: 10.2460/ajvr.23.11.0255 -
Annual International Conference of the... Jul 2023Cardiovascular disease, particularly Rheumatic Heart Disease (RHD), is one of the leading causes of death in many developing countries. RHD is manageable and treatable...
Cardiovascular disease, particularly Rheumatic Heart Disease (RHD), is one of the leading causes of death in many developing countries. RHD is manageable and treatable with early detection. However, multiple countries across the globe suffer from a scarcity of experienced physicians who can perform screening at large scales. Advancements in machine learning and signal processing have paved way for Phonocardiogram (PCG)-based automatic heart sound classification. The direct implication of such methods is that it is possible to enable a person without specialized training to detect potential cardiac conditions with just a digital stethoscope. Hospitalization or life-threatening situations can be dramatically reduced via such early screenings. Towards this, we conducted a case study amongst a population from a particular geography using machine learning and deep learning methods for the detection of murmur in heart sounds. The methodology consists of first pre-processing and identifying normal vs. abnormal heart sound signals using 3 state-of-the-art methods. The second step further identifies the murmur to be systolic or diastolic by capturing the auscultation location. Abnormal findings are then sent for early attention of clinicians for proper diagnosis. The case study investigates the efficacy of the automated method employed for early screening of potential RHD and initial encouraging results of the study are presented.
Topics: Humans; Heart Sounds; Algorithms; Heart Murmurs; Heart Diseases; Heart Auscultation
PubMed: 38083243
DOI: 10.1109/EMBC40787.2023.10340924 -
Annales de Cardiologie Et D'angeiologie Feb 2024Acute rheumatic fever (ARF) is a multi-systemic disease, in which cardiac involvement is the most serious major manifestation of disease. The aim of this study was to...
INTRODUCTION
Acute rheumatic fever (ARF) is a multi-systemic disease, in which cardiac involvement is the most serious major manifestation of disease. The aim of this study was to analyse cardiac involvement in children with ARF and his risk factors.
MATERIALS AND METHODS
It were a retrospective study including all children under the age of 14 years who were hospitalized for ARF in the pediatric department of the CHU Hédi Chaker of Sfax, during a period of twelve years (2010-2022).
RESULTS
We collected 50 cases (31 boys and 19 girls). Twenty-two patients (44%) developed cardiac lesions. The mean age at diagnosis was 9.6 years [5-14 years]. A pathological heart murmur was detected in 14 cases (n = 14/22) was classified as mild carditis in 15 cases, moderate carditis in 5 cases and severe in 2 cases. The median follow-up time was 3,3 years. Nineteen patients developed valvular sequelae Risk factors of cardiac lesions was: age more than 8 years, heart murmur, allonged PR, CRP > 100 mg/l and VS > 100 mm.
CONCLUSION
CR is still a public health problem in Tunisia. It is a serious pathology that can cause serious increases in morbidity rates. Thus, we must strengthen preventive strategies.
Topics: Child; Male; Female; Humans; Adolescent; Retrospective Studies; Myocarditis; Rheumatic Heart Disease; Rheumatic Fever; Heart Murmurs
PubMed: 37988890
DOI: 10.1016/j.ancard.2023.101676 -
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 -
Nature Reviews. Microbiology Jan 2024
Topics: Humans; Heart Murmurs; Bacteria
PubMed: 37932604
DOI: 10.1038/s41579-023-00991-2 -
Journal of the American Veterinary... Feb 2024
Topics: Dogs; Animals; Ductus Arteriosus, Patent; Heart Murmurs; Dog Diseases
PubMed: 37890502
DOI: 10.2460/javma.23.08.0465 -
Diagnostics (Basel, Switzerland) Oct 2023Technological advancement may bridge gaps between long-practiced medical competencies and modern technologies. Such a domain is the application of digital stethoscopes...
BACKGROUND
Technological advancement may bridge gaps between long-practiced medical competencies and modern technologies. Such a domain is the application of digital stethoscopes used for physical examination in telemedicine. This study aimed to validate the level of consensus among physicians regarding the interpretation of remote, digital auscultation of heart and lung sounds.
METHODS
Seven specialist physicians considered both the technical quality and clinical interpretation of auscultation findings of pre-recorded heart and lung sounds of patients hospitalized in their homes. TytoCare system was used as a remote, digital stethoscope.
RESULTS
In total, 140 sounds (70 heart and 70 lungs) were presented to seven specialists. The level of agreement was measured using Fleiss' Kappa (FK) variable. Agreement relating to heart sounds reached low-to-moderate consensus: the overall technical quality (FK = 0.199), rhythm regularity (FK = 0.328), presence of murmurs (FK = 0.469), appreciation of sounds as remote (FK = 0.011), and an overall diagnosis as normal or pathologic (FK = 0.304). The interpretation of some of the lung sounds reached a higher consensus: the overall technical quality (FK = 0.169), crepitus (FK = 0.514), wheezing (FK = 0.704), bronchial sounds (FK = 0.034), and an overall diagnosis as normal or pathological (FK = 0.386). Most Fleiss' Kappa values were in the range of "fare consensus", while in the domains of diagnosing lung crepitus and wheezing, the values increased to the "substantial" level.
CONCLUSIONS
Bio signals, as recorded auscultations of the heart and lung sounds serving the process of clinical assessment of remotely situated patients, do not achieve a high enough level of agreement between specialized physicians. These findings should serve as a catalyzer for improving the process of telemedicine-attained bio-signals and their clinical interpretation.
PubMed: 37835896
DOI: 10.3390/diagnostics13193153 -
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 -
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