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Annals of Biomedical Engineering Nov 2006Heart murmurs are often the first signs of pathological changes of the heart valves, and they are usually found during auscultation in the primary health care.... (Clinical Trial)
Clinical Trial
Heart murmurs are often the first signs of pathological changes of the heart valves, and they are usually found during auscultation in the primary health care. Distinguishing a pathological murmur from a physiological murmur is however difficult, why an "intelligent stethoscope" with decision support abilities would be of great value. Phonocardiographic signals were acquired from 36 patients with aortic valve stenosis, mitral insufficiency or physiological murmurs, and the data were analyzed with the aim to find a suitable feature subset for automatic classification of heart murmurs. Techniques such as Shannon energy, wavelets, fractal dimensions and recurrence quantification analysis were used to extract 207 features. 157 of these features have not previously been used in heart murmur classification. A multi-domain subset consisting of 14, both old and new, features was derived using Pudil's sequential floating forward selection (SFFS) method. This subset was compared with several single domain feature sets. Using neural network classification, the selected multi-domain subset gave the best results; 86% correct classifications compared to 68% for the first runner-up. In conclusion, the derived feature set was superior to the comparative sets, and seems rather robust to noisy data.
Topics: Aged; Algorithms; Artificial Intelligence; Diagnosis, Computer-Assisted; Female; Heart Auscultation; Heart Murmurs; Humans; Male; Pattern Recognition, Automated; Reproducibility of Results; Sensitivity and Specificity; Sound Spectrography
PubMed: 17019618
DOI: 10.1007/s10439-006-9187-4 -
Acta Veterinaria Scandinavica Sep 2021Cardiac auscultation is an important screening test at the first health examination of puppies because most clinically relevant congenital cardiac anomalies cause a loud...
BACKGROUND
Cardiac auscultation is an important screening test at the first health examination of puppies because most clinically relevant congenital cardiac anomalies cause a loud murmur from birth. This retrospective study aimed to investigate the age at which dogs with suspected congenital cardiac anomalies were referred to a veterinary cardiology specialist for murmur investigation. A secondary aim was to establish the time interval between the visit to the cardiologist and the first available murmur documentation. The digital archive of a veterinary teaching hospital was searched for dogs with congenital cardiac anomalies and puppies with innocent murmurs during a 5-year period. Dogs had to be referred because of a murmur, and they had to undergo physical examination and echocardiography by a veterinary cardiology specialist. The health certificate section of the pet passport, and the medical records from the referring veterinarian, were reviewed to identify the date when the murmur was first documented.
RESULTS
Of the 271 included dogs, 94% had a congenital cardiac anomaly and 6% had an innocent murmur. The dogs' median age was 190 days when they were examined by the cardiologist. Only 10% of the dogs were referred by the breeder's veterinarian, while 90% of the dogs were referred by the new owner's veterinarian. The median age of the first available murmur documentation by a first opinion veterinary practitioner was 95 days.
CONCLUSIONS
Only 10% of the puppies in the present study were referred to a veterinary cardiology specialist for murmur investigation before they were sold to a new owner. Referral prior to re-homing would have been feasible if the murmur had been detected and documented by the breeder's veterinarian, if referral was offered by the breeder's veterinarian and the referral was accepted by the breeder.
Topics: Animals; Cardiology; Dogs; Heart Murmurs; Hospitals, Animal; Hospitals, Teaching; Referral and Consultation; Retrospective Studies
PubMed: 34556139
DOI: 10.1186/s13028-021-00603-0 -
Journal of Veterinary Internal Medicine 1995Auscultatory, phonocardiographic (PCG), radiographic, and echocardiographic evidence of chronic valvular disease (CVD) were studied in 79 Cavalier King Charles Spaniels...
Auscultatory, phonocardiographic (PCG), radiographic, and echocardiographic evidence of chronic valvular disease (CVD) were studied in 79 Cavalier King Charles Spaniels with a mean age of 7.6 years (SD 2.6). Cardiac murmurs were present in 59 of the dogs and the intensity of the systolic cardiac murmur, assessed by auscultation (grade 1-6), was correlated (P < .001) to the severity of CVD (heart failure class) and to the echocardiographic dimensions of the heart (left atrial ratio, La/Ao-d, and left ventricular end diastolic diameter, LVEDD) (both P < .001). The heart sounds and duration of electromechanical systole (Q-S2) were investigated in all dogs using measurements obtained from PCG recordings. Normal regression equations describing the relation between heart rate and systolic intervals (Q-S1, Q-S2 and S1-S2) were established based on observations in 11 normal control Cavalier King Charles Spaniels. The total electromechanical systole (Q-S2), Q-S1, and S1-S2 intervals in the 59 dogs were related to the corresponding normal regression equation. A shortening of Q-S2 and S1-S2 intervals were found in dogs belonging to heart failure class I (Q-S2; P < .01 and S1-S2; P < .05), class II, and classes III and IV (both P < .001). The ratio of the amplitudes of the first (S1) and second heart sounds (S2) measured on the PCG recordings was found to be increased in dogs belonging to class I (P < .01), class II, and classes III and IV (both P < .001). The relationship between cardiac dimensions (LVEDD and La/Ao-d) and S1a/S2a ratio was described by quadratic regression and found to be significant for both parameters (LVEDD; P < .001, R2 = .54 and La/Ao-d; P < .001, R2 = .63). The presence of a third heart sound (S3) was detected, using PCG, in 21 of the 68 dogs. The proportion of dogs exhibiting S3 increased with heart failure class (and increasing cardiac dimensions) (P < .001). These findings were confirmed by observations in 13 Cavalier King Charles Spaniels with cardiac failure progressing from heart failure class I to class II (Mean LVEDD from 30.2 to 35.2 mm and mean La/Ao-d from 1.09 to 1.43). An increase in intensity of the heart murmur, assessed by auscultation, increase in the ratio of the amplitudes of S1 and S2, as well as a shortening in Q-S2 and S1-S2 intervals (all P < .01) were found in these dogs.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Analysis of Variance; Animals; Chronic Disease; Dog Diseases; Dogs; Echocardiography; Electrocardiography; Female; Heart Murmurs; Heart Sounds; Heart Valve Diseases; Male; Severity of Illness Index
PubMed: 7760313
DOI: 10.1111/j.1939-1676.1995.tb03276.x -
Journal of Veterinary Internal Medicine 2015The aims of this study were to establish the prevalence of innocent cardiac murmurs in clinically healthy puppies, to investigate a possible correlation between the...
BACKGROUND
The aims of this study were to establish the prevalence of innocent cardiac murmurs in clinically healthy puppies, to investigate a possible correlation between the presence of an innocent murmur and hematocrit, and to describe the auscultation characteristics of innocent murmurs.
HYPOTHESIS
Lower hematocrit contributes to the genesis of innocent murmurs.
ANIMALS
Five hundred and eighty-four client-owned clinically healthy puppies, between 20 and 108 days old.
METHODS
Two cross-sectional surveys with a 1-year (n = 389 pups) pilot and a half-year (n = 195 pups) principal study periods. Cardiac auscultation was performed by a single, board-certified cardiologist. Hematocrit was measured with an automatized hematology analyzer. Echocardiography was performed only on puppies with a cardiac murmur in the principal study.
RESULTS
In the pilot study, 15% of the dogs had a murmur. Innocent murmur was diagnosed in 28% of the 195 dogs in the principal study. Innocent murmurs were systolic, mostly with a musical character and with a maximal intensity of 2 of 6, and mostly with the point of maximal intensity in the left cardiac base. The hematocrit was significantly lower in the group with a murmur compared to the group without (P = .023).
CONCLUSIONS AND CLINICAL IMPORTANCE
Innocent murmur was a common finding in puppies at the age when the first veterinary controls usually take place. Physiologic anemia contributes to the genesis of innocent murmurs in puppies. Rising hematocrit in growing puppies can explain the spontaneous disappearance of innocent murmurs with aging. Hematocrit did not differentiate innocent murmurs from abnormal murmurs.
Topics: Animals; Cross-Sectional Studies; Dogs; Heart Auscultation; Heart Murmurs; Pilot Projects
PubMed: 26415555
DOI: 10.1111/jvim.13632 -
Journal of the American Veterinary... Aug 2004To assess the frequency of heart murmurs in overtly healthy cats.
OBJECTIVE
To assess the frequency of heart murmurs in overtly healthy cats.
DESIGN
Prospective study.
SAMPLE POPULATION
103 healthy domestic cats.
PROCEDURE
Background information and physical characteristics were assessed in cats that were candidates for blood donation during an 8-month period. For cats with heart murmurs, additional information collected included murmur timing, grade, point of maximal intensity, and presence of additional heart sounds.
RESULTS
Heart murmurs were detected in 22 of the 103 (21%) cats. Echocardiography was performed in 7 of those 22 cats. The echocardiogram was considered normal in 1 cat; in the other 6 cats, diagnoses included hypertrophic cardiomyopathy (interventricular septal hypertrophic form [IVSH]; n = 4), left ventricular concentric hypertrophy with valvular disease (1), and equivocal IVSH (1). Thirteen cats had more than 1 examination during the study; 3 of them developed heart murmurs. There were no significant differences in age, sex, breed, coat color, eye color, or heart rate between cats with and without murmurs. Among the 103 cats, there were 6 pairs of siblings from 6 multiple-cat households and 16 cats from 7 multiple-cat households in which the cats were not related; the proportion of cats with murmurs was higher in the related cats (5/12) than in the unrelated cats (3/16), but the difference was not significant.
CONCLUSIONS AND CLINICAL RELEVANCE
Results indicated that heart murmurs are detectable in a large proportion of overtly healthy cats and that many murmurs appear to be caused by structural heart disease that is in a clinically latent state.
Topics: Animals; Cardiomyopathy, Hypertrophic; Cat Diseases; Cats; Echocardiography; Female; Heart Diseases; Heart Murmurs; Male; Prevalence; Prospective Studies
PubMed: 15328713
DOI: 10.2460/javma.2004.225.384 -
International Journal of Nanomedicine 2012Auscultation of the heart is accompanied by both electrical activity and sound. Heart auscultation provides clues to diagnose many cardiac abnormalities. Unfortunately,...
Auscultation of the heart is accompanied by both electrical activity and sound. Heart auscultation provides clues to diagnose many cardiac abnormalities. Unfortunately, detection of relevant symptoms and diagnosis based on heart sound through a stethoscope is difficult. The reason GPs find this difficult is that the heart sounds are of short duration and separated from one another by less than 30 ms. In addition, the cost of false positives constitutes wasted time and emotional anxiety for both patient and GP. Many heart diseases cause changes in heart sound, waveform, and additional murmurs before other signs and symptoms appear. Heart-sound auscultation is the primary test conducted by GPs. These sounds are generated primarily by turbulent flow of blood in the heart. Analysis of heart sounds requires a quiet environment with minimum ambient noise. In order to address such issues, the technique of denoising and estimating the biomedical heart signal is proposed in this investigation. Normally, the performance of the filter naturally depends on prior information related to the statistical properties of the signal and the background noise. This paper proposes Kalman filtering for denoising statistical heart sound. The cycles of heart sounds are certain to follow first-order Gauss-Markov process. These cycles are observed with additional noise for the given measurement. The model is formulated into state-space form to enable use of a Kalman filter to estimate the clean cycles of heart sounds. The estimates obtained by Kalman filtering are optimal in mean squared sense.
Topics: Algorithms; Heart Murmurs; Heart Sounds; Humans; Phonocardiography; Signal Processing, Computer-Assisted; Signal-To-Noise Ratio
PubMed: 22745550
DOI: 10.2147/IJN.S32315 -
Journal of Cardiology Dec 2020The widespread use of cardiac computed tomography (CT) has increased the incidental discovery of fistulas of the coronary artery (CAF). This condition is rare and can...
Coronary artery fistula in adults: Incidence and appearance on cardiac computed tomography and comparison of detectability and hemodynamic effects with those on transthoracic echocardiography.
BACKGROUND
The widespread use of cardiac computed tomography (CT) has increased the incidental discovery of fistulas of the coronary artery (CAF). This condition is rare and can affect hemodynamic parameters, but few reports focus on its hemodynamic effects. We investigated the frequency and types of CAF on CT and compared them with those of transthoracic echocardiography (TTE) to evaluate the detectability of CAF and its hemodynamic effects.
MATERIALS AND METHODS
We retrospectively evaluated cardiac CT images of 6789 adult patients who underwent imaging from January 1, 2013 through September 30, 2019 at our institution. We assessed the CT images for the presence of CAF and compared our findings with those obtained by TTE in control cases without CAF.
RESULTS
The prevalence of CAF determined with cardiac CT was 0.91%, with the left anterior descending artery (67.7%) as the most common site of origin and the main pulmonary artery (82.3%) as the most common origin of drainage. The incidence of aneurysm accompanying CAF was 48.4%. Color Doppler in TTE demonstrated abnormal flow that would suggest the presence of CAF of only 23.1%. Echocardiographic findings of hemodynamics did not differ significantly between patients with and without CAF nor between elderly and non-elderly patients with CAF.
CONCLUSIONS
Our study revealed differing prevalence and types of CAF from those reported using coronary angiography and little impact of CAF on hemodynamics. Color Doppler in TTE did not readily depict abnormal flow that might suggest the presence of a fistula, but cardiac CT allowed noninvasive and comprehensive assessment of CAF. Thus, we believe the acquisition of cardiac CT is necessary to establish the cause of continuous murmur that is not identified with TTE.
Topics: Adult; Aged; Aged, 80 and over; Arterio-Arterial Fistula; Coronary Artery Disease; Echocardiography; Female; Heart Murmurs; Hemodynamics; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 32636129
DOI: 10.1016/j.jjcc.2020.06.005 -
British Heart Journal Jan 1949
Topics: Heart; Heart Murmurs; Heart Sounds; Humans; Sound
PubMed: 18113468
DOI: 10.1136/hrt.11.1.41 -
BMC Pediatrics Nov 2015Detection of a heart murmur in healthy children is common, but may generate anxiety among parents. Many parents believe a heart murmur is a sign of heart disease,... (Observational Study)
Observational Study
BACKGROUND
Detection of a heart murmur in healthy children is common, but may generate anxiety among parents. Many parents believe a heart murmur is a sign of heart disease, although the majority of heart murmurs are innocent. The purpose of this study was to assess anxiety and concerns in parents of children referred for evaluation of a heart murmur and to evaluate the effect of receiving a fact sheet about heart murmurs before the cardiologic consultation.
METHODS
Parents of children referred for evaluation of a heart murmur responded to questionnaires assessing family and patient characteristics, parental concerns and anxiety. Anxiety was measured using the State Trait Anxiety Index (STAI) before and two weeks after the consultation. One third of the parents received a fact sheet before the consultation.
RESULTS
Two hundred fifty-eight parents of 178 children participated. About 60 % of the parents had an increased level of anxiety before the consultation. The majority of the parents (71 %) had at least one major concern about heart murmurs in children, and having a concern was related to higher anxiety levels (p = 0.02). Anxious personality and lower education predicted an increased anxiety level. Before the consultation, parents who received a fact sheet presented a lower mean STAI state anxiety level (33.2) than those who did not (35.3), but the difference was not significant (p = 0.09). Fewer parents in the intervention group believed their child would have increased risk of heart disease later in life (p = 0.04) or that heart murmurs in children represents valvular-or congenital heart disease (p = 0.02). After the consultation, parental anxiety decreased from a mean STAI state of 34.9 to 30.6 (p < 0.01), and the mean STAI state scores were similar for the control and intervention group.
CONCLUSION
Parents with a child referred for a heart murmur presented a higher mean anxiety level than pre-school parents, and having an anxious personality, a major concern or low education predicted an increased anxiety level. After the consultation, parental anxiety decreased. Receiving a fact sheet about heart murmurs did not significantly reduce parental anxiety levels, but had a modest effect on concerns for the consequences of a heart murmur.
Topics: Adolescent; Anxiety; Child; Child, Preschool; Educational Status; Female; Heart Diseases; Heart Murmurs; Humans; Infant; Male; Parents; Patient Education as Topic; Personality; Referral and Consultation; Risk Factors; Surveys and Questionnaires
PubMed: 26590070
DOI: 10.1186/s12887-015-0507-4 -
Heart (British Cardiac Society) Nov 2005The detection of an ejection systolic murmur in the aortic valve region often corresponds to a diagnosis of aortic sclerosis or minor disruption of the aortic valve with... (Review)
Review
The detection of an ejection systolic murmur in the aortic valve region often corresponds to a diagnosis of aortic sclerosis or minor disruption of the aortic valve with associated turbulence but minimal obstruction. Aortic sclerosis has two important clinical implications. Firstly, aortic sclerosis is an antecedent to clinically significant aortic valve obstruction and, secondly, it acts as a marker of increased risk of cardiovascular events. This article reviews the evidence that aortic sclerosis is a useful adjunctive tool in cardiovascular risk stratification and that its progression to haemodynamically significant aortic stenosis is a potential focus for individual monitoring and for interventional studies.
Topics: Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Biomarkers; Calcinosis; Disease Progression; Echocardiography; Heart Murmurs; Humans; Middle Aged; Prognosis; Risk Assessment; Risk Factors; Sclerosis; Tomography, X-Ray Computed
PubMed: 15797932
DOI: 10.1136/hrt.2004.057117