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Annals of Medicine and Surgery (2012) Oct 2023Although clinical guidelines suggest echocardiography before surgery in patients with hip fracture, no prospective studies exist in the literature. The aim of the...
INTRODUCTION
Although clinical guidelines suggest echocardiography before surgery in patients with hip fracture, no prospective studies exist in the literature. The aim of the present investigation was to assess whether preoperative echocardiography affects time to surgery, length of hospital stay (LOS), and in hospital mortality in high-risk patients who need surgery for a hip fracture.
MATERIAL AND METHODS
In the study entered 255 consecutive patients with hip fracture referred to a multidisciplinary hip fracture unit. Seven hundred seventeen patients referred before the implementation of routine echocardiographic examination were considered as control group. Echocardiography was performed in patients with systolic murmurs, unstable clinical conditions, recent decompensation of heart failure or hospital admission for coronary disease. Time to surgery, LOS, and in hospital mortality in patients who underwent preoperative echocardiography (high-risk group) were compared with patients who did not undergo echo (low-risk group) and with the control group.
RESULTS
122/255 patients underwent echocardiography. The two groups did not differ for age, sex, type or fracture, and notably time to surgery and LOS. Coronary heart disease, atrial fibrillation, and two or more comorbidities were more frequent in the echo group. Overall clinical characteristics were not different from group of patients referred before the implementation of the echocardiographic protocol but in these last patients time to surgery and LOS were significantly longer. As well in hospital mortality was not significantly different in the two groups (1.9 in echo vs. 1.7% in nonecho) but lower than in the control group (4.1% ).
CONCLUSIONS
An echocardiographic guide may be useful in a high-risk group with a hip fracture to choose the proper anesthetic setting, referral for intensive care observation after surgery and, optimal medical treatment, including fluid management without delay in time to surgery.
PubMed: 37811064
DOI: 10.1097/MS9.0000000000001151 -
Journal of Cardiology Apr 2024In the aging global society, heart failure and valvular heart diseases, including aortic stenosis, are affecting millions of people and healthcare systems worldwide.... (Review)
Review
In the aging global society, heart failure and valvular heart diseases, including aortic stenosis, are affecting millions of people and healthcare systems worldwide. Although the number of effective treatment options has increased in recent years, the lack of effective screening methods is provoking continued high mortality and rehospitalization rates. Appropriately, auscultation has been the primary option for screening such patients, however, challenges arise due to the variability in auscultation skills, the objectivity of the clinical method, and the presence of sounds inaudible to the human ear. To address challenges associated with the current approach towards auscultation, the hardware of Super StethoScope was developed. This paper is composed of (1) a background literature review of bioacoustic research regarding heart disease detection, (2) an introduction of our approach to heart sound research and development of Super StethoScope, (3) a discussion of the application of remote auscultation to telemedicine, and (4) results of a market needs survey on traditional and remote auscultation. Heart sounds and murmurs, if collected properly, have been shown to closely represent heart disease characteristics. Correspondingly, the main characteristics of Super StethoScope include: (1) simultaneous collection of electrocardiographic and heart sound for the detection of heart rate variability, (2) optimized signal-to-noise ratio in the audible frequency bands, and (3) acquisition of heart sounds including the inaudible frequency ranges. Due to the ability to visualize the data, the device is able to provide quantitative results without disturbance by sound quality alterations during remote auscultations. An online survey of 3648 doctors confirmed that auscultation is the common examination method used in today's clinical practice and revealed that artificial intelligence-based heart sound analysis systems are expected to be integrated into clinicians' practices. Super StethoScope would open new horizons for heart sound research and telemedicine.
Topics: Humans; Stethoscopes; Heart Sounds; Artificial Intelligence; Auscultation; Heart Diseases; Heart Auscultation
PubMed: 37734656
DOI: 10.1016/j.jjcc.2023.09.007 -
European Heart Journal. Case Reports Sep 2023Rheumatic heart disease is a major disease that seriously affects human health and survival worldwide. Rheumatic mitral stenosis often has relatively complex...
BACKGROUND
Rheumatic heart disease is a major disease that seriously affects human health and survival worldwide. Rheumatic mitral stenosis often has relatively complex pathological changes, and its progression leads to various manifestations of mitral valve dysfunction and adverse clinical events.
CASE SUMMARY
We present a 60-year-old patient who developed chest tightness, shortness of breath, and bilateral lower limb oedema in 2018 (New York Heart Association functional class III). Systolic and diastolic murmurs could be heard in the mitral auscultation area. In December 2021, the patient was admitted to the hospital with stroke. Thereafter, transthoracic echocardiography and computed tomography were performed, and the progress of rheumatic mitral stenosis was recorded. Due to the patient's high surgical risk, a patient-specific three-dimensional printed model was used to observe anatomical structures and simulate main procedures, and the surgeons finally chose to perform transcatheter mitral valve replacement. The balloon-expandable bioprothesis was released from the right femoral artery to treat the rheumatic mitral stenosis. The patient remained asymptomatic at the 6-month follow-up.
DISCUSSION
For patients with rheumatic mitral stenosis with high surgical risk, it is feasible to conduct transcatheter mitral valve replacement under the guidance of three-dimensional printing.
PubMed: 37718998
DOI: 10.1093/ehjcr/ytad434 -
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 -
Chest Sep 2023
Topics: Humans; Fatigue; Heart Murmurs
PubMed: 37689478
DOI: 10.1016/j.chest.2022.09.050 -
Journal of Family Medicine and Primary... Jul 2023Cardiac diseases in the pediatric population can be congenital or acquired. If the diagnosis and treatment are early, the chance for survival increases. Thus, this study...
OBJECTIVES
Cardiac diseases in the pediatric population can be congenital or acquired. If the diagnosis and treatment are early, the chance for survival increases. Thus, this study aimed to determine the indications for pediatric cardiology consultations in a single tertiary hospital in Jeddah, Saudi Arabia.
MATERIALS AND METHODS
This study was conducted in 2020-2021 at a tertiary center in Jeddah, Saudi Arabia. Patients younger than 14 years of age who were referred by outpatient clinics or those who presented to the emergency department and needed outpatient cardiac evaluation were included in this study. Inpatient referrals were excluded. The Statistical Package for the Social Sciences version 21 was used for statistical analyses.
RESULTS
A total of 416 referred patients were included in this study. New patients accounted for 74% of the referrals, while known patients accounted for 26%. The median age was 2.728 years, with 56.3% being male participants. The three most common reasons for referral were: evaluation of cardiac function (21.6%), follow-up evaluation of fetal/neonatal diagnosis (19.5%), and heart murmurs (16.8%).
CONCLUSION
Most of the referrals were new patients. Of those who underwent echocardiography, 48.2% had abnormal results. We recommend further studies to help guide the direction of the residents' education and to provide better patient healthcare services.
PubMed: 37649738
DOI: 10.4103/jfmpc.jfmpc_65_23 -
Journal of the American Heart... Sep 2023Background Short-term effects on mitral valve (MV) anatomy after transcatheter edge-to-edge repair using the PASCAL system remain unknown. Precise quantification might...
Background Short-term effects on mitral valve (MV) anatomy after transcatheter edge-to-edge repair using the PASCAL system remain unknown. Precise quantification might allow for an advanced analysis of predictors for mean transmitral gradients. Methods and Results Consecutive patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation using PASCAL or MitraClip systems were included. Quantification of short-term MV changes throughout the cardiac cycle was performed using peri-interventional 3-dimensional MV images. Predictors for mean transmitral gradients were identified in univariable and multivariable regression analysis. Long-term results were described during 1-year follow-up. A total of 100 patients undergoing transcatheter edge-to-edge repair using PASCAL (n=50) or MitraClip systems (n=50) were included. Significant reductions of anterior-posterior diameter, annular circumference, and area throughout the cardiac cycle were found in both cohorts (<0.05 for all). Anatomic MV orifice area remained larger in the PASCAL cohort in mid (2.8±1.0 versus 2.4±0.9 cm; =0.049) and late diastole (2.7±1.1 versus 2.2±0.8 cm; =0.036) compared with the MitraClip cohort. Besides a device-specific profile of independent predictor of mean transmitral gradients, reduction of middiastolic anatomic MV orifice area was identified as an independent predictor in both the PASCAL (=-0.410; =0.001) and MitraClip cohorts (=-0.318; =0.028). At follow-up, reduction of mitral regurgitation grade to mild or less was more durable in the PASCAL cohort (90% versus 72%; =0.035). Conclusions PASCAL and MitraClip showed comparable short-term effects on MV geometry. However, PASCAL might better preserve MV function and demonstrated more durable mitral regurgitation reduction during follow-up. Identification of independent predictors for mean transmitral gradients might potentially help to guide device selection in the future.
Topics: Humans; Heart Murmurs; Mitral Valve; Mitral Valve Insufficiency
PubMed: 37646220
DOI: 10.1161/JAHA.123.030333 -
Nederlands Tijdschrift Voor Geneeskunde Aug 2023Feeding problems in children are usually harmless and common, but can rarely exist as a result of pathology. Heart failure is one of them and has to be recognized early...
Feeding problems in children are usually harmless and common, but can rarely exist as a result of pathology. Heart failure is one of them and has to be recognized early because of its many consequences. We present a 15-week-old female infant who was seen at the outpatient clinic. She had already been evaluated several times by a youth doctor and general practitioner because of feeding problems and transpiration, for which several nutritional interventions had already been carried out. With no effect of nutritional interventions she was referred to a pediatrician. Physical examination showed clear signs of heart failure and echocardiogram showed a severe dilation of the left ventricle, with poor contractility of the lateral wall and papillary muscle, with end stage heart failure due to an Anomalous Left Coronary Artery from the Pulmonary Artery (ALPACA). In this article we discuss the clinical presentation of heart failure: stagnant growth, exercise intolerance, tachypnea and sometimes hepatomegaly, edema, murmurs or cyanosis. In addition, when a patient does not respond to initial therapy, we recommend to reconsider differential diagnosis and/or refer to a pediatrician.
Topics: Infant; Adolescent; Humans; Child; Female; Child, Preschool; Heart Failure; Ambulatory Care Facilities; Cyanosis; Diagnosis, Differential; Echocardiography
PubMed: 37609929
DOI: No ID Found -
Pediatric Emergency Care Oct 2023Diagnosis of acute myocarditis or dilated cardiomyopathy (DCM) on initial presentation is difficult in children younger than 2 years because most present with complaints...
OBJECTIVE
Diagnosis of acute myocarditis or dilated cardiomyopathy (DCM) on initial presentation is difficult in children younger than 2 years because most present with complaints suggestive of a respiratory infection. The objective of this study is to determine whether signs, symptoms, and diagnostic studies excluding those of heart failure, done routinely in the emergency department could distinguish children younger than 2 years with acute myocarditis or DCM from those with respiratory illnesses.
METHODS
Sixty-four infants' charts, 32 cases and 32 controls, were reviewed from January 1, 2009, through December 31, 2020. Controls were matched to cases with respect to age, reason, and time of admission. Signs, symptoms, and blood gases were reviewed.
RESULTS
The median age is 6.5 (0.5-22) months in both groups. Infants presenting with signs of heart failure including murmurs ( P = 0.002), prolonged capillary refill ( P = 0.024), cool, mottled extremities ( P = 0.002), poor perfusion ( P = 0.001), or hepatomegaly ( P < 0.001) were more likely to be diagnosed with acute myocarditis or DCM when compared with the control group with respiratory disease. Infants with fever ( P = 0.017), nasal congestion ( P < 0.001), rhinorrhea ( P < 0.001), cough ( P < 0.001), and wheezing ( P < 0.001) were more likely to have a respiratory illness than acute myocarditis or DCM. The presence of a lower p co2 (30 [14-116] vs 40 [31-59] mm Hg, P < 0.001), lower bicarbonate (16.7 [6.3-23.4] vs 21.7 [16-28.4], P < 0.001), or an oxygen saturation > 95% ( P = 0.004) was observed in infants with acute myocarditis or DCM compared with those with respiratory illness. By multivariable analysis, infants with tachycardia in the absence of fever, metabolic acidosis, and an oxygen saturation > 95% were more likely to have acute myocarditis or DCM than those without this disease.
CONCLUSIONS
Children younger than 2 years presenting to the emergency department with tachycardia and no fever, metabolic acidosis, and a high oxygen saturation should be investigated for acute myocarditis or DCM.
Topics: Infant; Child; Humans; Myocarditis; Cardiomyopathy, Dilated; Heart Failure; Early Diagnosis
PubMed: 37590924
DOI: 10.1097/PEC.0000000000003038 -
European Heart Journal. Case Reports Aug 2023Pericarditis is a common pericardial disorder that is frequently accompanied by a pericardial friction rub, which can be detected during a physical examination. Although...
BACKGROUND
Pericarditis is a common pericardial disorder that is frequently accompanied by a pericardial friction rub, which can be detected during a physical examination. Although patients' awareness of cardiac murmurs and vascular bruits has been extensively reported, there are no reports on patients' self-awareness of a pericardial friction rub.
CASE SUMMARY
We present the first case of a patient with acute pericarditis associated with objective self-awareness of a pericardial friction rub, which we recorded with an electronic stethoscope and confirmed the sound with the patient. The patient had a recent history of three-vessel coronary artery bypass grafting and presented with a progressively worsening, rhythmic, and 'sandpaper-scratching' sound in both ears. The sound was more pronounced in the left lateral decubitus position. The symptom resolved with colchicine therapy and was associated with concomitant resolution of the pericardial friction rub.
DISCUSSION
This is the first documented case of a patient demonstrating objective self-awareness of a pericardial rub resulting from acute pericarditis associated with post-pericardiotomy syndrome. Tinnitus refers to the perception of an auditory sensation that can be subjective or objective, depending on whether it is heard only by the individual or can also be heard by an observer. While objective tinnitus caused by cardiovascular conditions has been previously reported, no cases have attributed the pericardial friction rub as the underlying cause. Therefore, we suggest using the term pericardial rub tinnitus to describe this unique phenomenon.
PubMed: 37547373
DOI: 10.1093/ehjcr/ytad333