Authors: Brian Ford, Sebastian Lara, James Park...

Up to 8.6% of infants and 80% of children have a heart murmur during their early years of life. The presence of a murmur can indicate conditions ranging from no discernable pathology to acquired or congenital heart disease. In infants with a murmur, physicians should review the obstetric and family histories to detect the possibility of congenital heart pathologies. Evaluation by a pediatric cardiologist is indicated for newborns with a murmur because studies show that neonatal murmurs have higher rates of pathology than in older children, and neonatal murmur characteristics are more difficult to evaluate during examination; referral is preferred over echocardiography. All infants, with or without a murmur, should have pulse oximetry screening to detect underlying critical congenital heart disease. In older children, most murmurs are innocent and can be followed with serial examinations if there are no findings of concern. Findings in older children that warrant referral include diastolic murmurs, loud or harsh-sounding murmurs, holosystolic murmurs, murmurs that radiate to the back or neck, or signs or symptoms of cardiac disease. Referral to a pediatric cardiologist is indicated when a pathologic murmur is suspected. Electrocardiography, chest radiography, and other tests should not be reflexively performed as part of all murmur evaluations because these tests can misclassify a murmur as innocent or pathologic, and they are not cost-effective. Emerging technologies include phonocardiography interpretation of murmurs and artificial intelligence algorithms for differentiating innocent from pathologic murmurs.

Topics: Artificial Intelligence; Child; Echocardiography; Electrocardiography; Heart Defects, Congenital; Heart Murmurs; Humans; Infant; Infant, Newborn

PubMed: 35289571
DOI: No ID Found

Review

Authors: V B Reef, J Bonagura, R Buhl...

Murmurs and arrhythmias are commonly detected in equine athletes. Assessing the relevance of these cardiovascular abnormalities in the performance horse can be challenging. Determining the impact of a cardiovascular disorder on performance, life expectancy, horse and rider or driver safety relative to the owner's future expectations is paramount. A comprehensive assessment of the cardiovascular abnormality detected is essential to determine its severity and achieve these aims. This consensus statement presents a general approach to the assessment of cardiovascular abnormalities, followed by a discussion of the common murmurs and arrhythmias. The description, diagnosis, evaluation, and prognosis are considered for each cardiovascular abnormality. The recommendations presented herein are based on available literature and a consensus of the panelists. While the majority of horses with cardiovascular abnormalities have a useful performance life, periodic reexaminations are indicated for those with clinically relevant cardiovascular disease. Horses with pulmonary hypertension, CHF, or complex ventricular arrhythmias should not be ridden or driven.

Topics: Animals; Aortic Valve Insufficiency; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiovascular Abnormalities; Heart Murmurs; Heart Septal Defects, Ventricular; Horse Diseases; Horses; Mitral Valve Insufficiency; Tricuspid Valve Insufficiency

PubMed: 24628586
DOI: 10.1111/jvim.12340

Review

Authors: Edin Begic, Zijo Begic

INTRODUCTION

Accidental murmurs occur in anatomically and physiologically normal heart. Accidental (innocent) murmurs have their own clearly defined clinical characteristics (asymptomatic, they require minimal follow-up care).

AIM

To point out the significance of auscultation of the heart in the differentiation of heart murmurs and show clinical characteristics of accidental heart murmurs.

MATERIAL AND METHODS

Article presents review of literature which deals with the issue of accidental heart murmurs in the pediatric cardiology.

RESULTS

In the group of accidental murmurs we include classic vibratory parasternal-precordial Stills murmur, pulmonary ejection murmur, the systolic murmur of pulmonary flow in neonates, venous hum, carotid bruit, Potaine murmur, benign cephalic murmur and mammary souffle.

CONCLUSION

Accidental heart murmurs are revealed by auscultation in over 50% of children and youth, with a peak occurrence between 3-6 years or 8-12 years of life. Reducing the frequency of murmurs in the later period can be related to poor conduction of the murmur, although the disappearance of murmur in principle is not expected. It is the most common reason of cardiac treatment of the child, and is a common cause of unreasonable concern of parents.

Topics: Asymptomatic Diseases; Diagnosis, Differential; Heart; Heart Auscultation; Heart Murmurs; Heart Sounds; Humans

PubMed: 28974851
DOI: 10.5455/medarh.2017.71.284-287

Authors: Joshua G Travers, Sara A Wennersten, Brisa Peña...

BACKGROUND

Diastolic dysfunction (DD) is associated with the development of heart failure and contributes to the pathogenesis of other cardiac maladies, including atrial fibrillation. Inhibition of histone deacetylases (HDACs) has been shown to prevent DD by enhancing myofibril relaxation. We addressed the therapeutic potential of HDAC inhibition in a model of established DD with preserved ejection fraction.

METHODS

Four weeks after uninephrectomy and implantation with deoxycorticosterone acetate pellets, when DD was clearly evident, 1 cohort of mice was administered the clinical-stage HDAC inhibitor ITF2357/Givinostat. Echocardiography, blood pressure measurements, and end point invasive hemodynamic analyses were performed. Myofibril mechanics and intact cardiomyocyte relaxation were assessed ex vivo. Cardiac fibrosis was evaluated by picrosirius red staining and second harmonic generation microscopy of left ventricle (LV) sections, RNA sequencing of LV mRNA, mass spectrometry-based evaluation of decellularized LV biopsies, and atomic force microscopy determination of LV stiffness. Mechanistic studies were performed with primary rat and human cardiac fibroblasts.

RESULTS

HDAC inhibition normalized DD without lowering blood pressure in this model of systemic hypertension. In contrast to previous models, myofibril relaxation was unimpaired in uninephrectomy/deoxycorticosterone acetate mice. Furthermore, cardiac fibrosis was not evident in any mouse cohort on the basis of picrosirius red staining or second harmonic generation microscopy. However, mass spectrometry revealed induction in the expression of >100 extracellular matrix proteins in LVs of uninephrectomy/deoxycorticosterone acetate mice, which correlated with profound tissue stiffening based on atomic force microscopy. ITF2357/Givinostat treatment blocked extracellular matrix expansion and LV stiffening. The HDAC inhibitor was subsequently shown to suppress cardiac fibroblast activation, at least in part, by blunting recruitment of the profibrotic chromatin reader protein BRD4 (bromodomain-containing protein 4) to key gene regulatory elements.

CONCLUSIONS

These findings demonstrate the potential of HDAC inhibition as a therapeutic intervention to reverse existing DD and establish blockade of extracellular matrix remodeling as a second mechanism by which HDAC inhibitors improve ventricular filling. Our data reveal the existence of pathophysiologically relevant covert or hidden cardiac fibrosis that is below the limit of detection of histochemical stains such as picrosirius red, highlighting the need to evaluate fibrosis of the heart using diverse methodologies.

Topics: Animals; Disease Models, Animal; Extracellular Matrix; Female; Heart Murmurs; Histone Deacetylase Inhibitors; Humans; Male; Mice; Ventricular Remodeling

PubMed: 33682427
DOI: 10.1161/CIRCULATIONAHA.120.046462

Review

Authors: Mediha Kardasevic, Amel Kardasevic

INTRODUCTION

Heart murmurs can be functional (innocent) and pathological (organic). Although it is not considered a major sign of heart disease, it may be a sign of a serious heart defect. In most cases the noise is initiation for cardiac treatment. Is it possible to differentiate on the basis of auscultation innocent from pathological heart murmur? In this article we present the results of ultrasonography of newborns with positive auscultation finding of the heart in the neonatal and early infancy period.

GOAL

To determine the role of murmurs in the heart detected by routine clinical examination in the neonatal period and early infancy, and to establish the legitimacy of cardiology consultation and ultrasound of the heart.

METHODS

A retrospective review of medical records in the period from January 1 to December 31, 2011 at the Maternity ward of Cantonal Hospital in Bihac 1899 children was born. In 32 neonates was registered a heart murmur, in the period from birth up to 6 weeks of life. All children with positive auscultation finding of the heart were examined echocardiography by ultrasound ALOCA 2000, multifrequency probe from 3.5 to 5 MHz, and used M-mode, 2-D, continuous, pulsed and color Doppler.

RESULTS

Of the 32 examined children regular echocardiographic findings had two children (6.25%), aberrant bunch of left ventricle 11 (34.37%), patent foramen ovale 5 (15.62%), atrial septal defect 3 children (9.37%), ventricular septal defect 8 children (25%), cyanogen anomaly 2 children (6.25%), stenosis of the pulmonary artery 1 child (3.12%). We see that 14 children (43.75%) had a structural abnormality of the heart that requires further treatment and monitoring.

CONCLUSION

Echocardiography is necessary to set up or refute the diagnosis of structural heart defect in children with positive auscultation finding in the neonatal period.

Topics: Congenital Abnormalities; Echocardiography; Female; Heart Auscultation; Heart Murmurs; Humans; Infant; Infant, Newborn; Male; Retrospective Studies

PubMed: 25568554
DOI: 10.5455/medarh.2014.68.282-284

Authors: A W SLOAN

Topics: Heart Murmurs; Heart Sounds; Humans; Phonocardiography

PubMed: 14849852
DOI: No ID Found

Authors: E G DIMOND, A BENCHIMOL

In phonocardiography the second heart sound is important in appraisal of congenital heart disease and pulmonary hypertension because it reflects the duration of right ventricular systoles. The systolic murmur in patients with intracardiac shunt decreases as pulmonary hypertension develops, and may eventually disappear completely as the pulmonary pressure reaches systemic level. Reference tracings in phonocardiography are useful for showing the interrelationship of the various cardiac sounds and murmurs.

Topics: Heart Defects, Congenital; Heart Murmurs; Heart Sounds; Humans; Hypertension, Pulmonary; Phonocardiography; Systole; Systolic Murmurs

PubMed: 13722948
DOI: No ID Found

Authors: Danyal Ladha, Karima Khamisa, Steven Promislow...

Topics: Aged; Anemia, Hemolytic; Heart Murmurs; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve Insufficiency; Prosthesis Failure

PubMed: 34580148
DOI: 10.1503/cmaj.202620-f

Authors: Andoni Elola, Elisabete Aramendi, Jorge Oliveira...

OBJECTIVE

Murmurs are abnormal heart sounds, identified by experts through cardiac auscultation. The murmur grade, a quantitative measure of the murmur intensity, is strongly correlated with the patient's clinical condition. This work aims to estimate each patient's murmur grade (i.e., absent, soft, loud) from multiple auscultation location phonocardiograms (PCGs) of a large population of pediatric patients from a low-resource rural area.

METHODS

The Mel spectrogram representation of each PCG recording is given to an ensemble of 15 convolutional residual neural networks with channel-wise attention mechanisms to classify each PCG recording. The final murmur grade for each patient is derived based on the proposed decision rule and considering all estimated labels for available recordings. The proposed method is cross-validated on a dataset consisting of 3456 PCG recordings from 1007 patients using a stratified ten-fold cross-validation. Additionally, the method was tested on a hidden test set comprised of 1538 PCG recordings from 442 patients.

RESULTS

The overall cross-validation performances for patient-level murmur gradings are 86.3% and 81.6% in terms of the unweighted average of sensitivities and F1-scores, respectively. The sensitivities (and F1-scores) for absent, soft, and loud murmurs are 90.7% (93.6%), 75.8% (66.8%), and 92.3% (84.2%), respectively. On the test set, the algorithm achieves an unweighted average of sensitivities of 80.4% and an F1-score of 75.8%.

CONCLUSIONS

This study provides a potential approach for algorithmic pre-screening in low-resource settings with relatively high expert screening costs.

SIGNIFICANCE

The proposed method represents a significant step beyond detection of murmurs, providing characterization of intensity, which may provide an enhanced classification of clinical outcomes.

Topics: Humans; Child; Phonocardiography; Heart Murmurs; Heart Auscultation; Algorithms; Auscultation; Heart Sounds

PubMed: 37163396
DOI: 10.1109/JBHI.2023.3275039

Authors: Arif Huq, Atifur Rahman

BACKGROUND

Approximately 50% of children experience a cardiac murmur at some point in their lives; <1% of these murmurs are attributed to congenital heart disease (CHD). Cardiac murmur might be the first clinical sign of a significant CHD in children. Despite careful routine medical examinations at birth, approximately 50% of CHD cases could remain unrecognised.

OBJECTIVE

Cardiovascular symptoms and signs could be specific or non-specific in neonates and children with heart murmurs. Knowledge about red flags in history and physical examinations, and syndromic associations of common CHDs are important. Auscultatory skills to identify systolic, diastolic and continuous murmurs and heart sounds are essential. Differential diagnosis should be formulated based on the location of maximum intensity of murmurs. Younger infants and children with pathological murmurs and red-flag signs should be promptly referred to local paediatric cardiology services for further investigations.

DISCUSSION

Significant skill and knowledge are required for the identification of critical murmurs and associated cardiovascular problems. This review provides a simplified comprehensive update on cardiac murmurs and associated conditions in neonates and children.

Topics: Humans; Heart Murmurs; Child; Infant; Heart Defects, Congenital; Child, Preschool; Diagnosis, Differential; Infant, Newborn; Heart Auscultation; Physical Examination

PubMed: 38957059
DOI: 10.31128/AJGP-06-23-6853