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Journal of Veterinary Cardiology : the... Apr 2023Systolic murmurs in the absence of cardiac structural abnormalities are common in cats. Narrow aorto-septal angle (AoSA) and septal remodeling can be a cause of a...
INTRODUCTION/OBJECTIVES
Systolic murmurs in the absence of cardiac structural abnormalities are common in cats. Narrow aorto-septal angle (AoSA) and septal remodeling can be a cause of a systolic murmur in elderly human beings. The aim of this study was to measure the AoSA in cats and to investigate the association between the AoSA and the presence of a murmur and isolated basal septal hypertrophy (IBSH).
ANIMALS
The study population comprised 122 cats.
MATERIALS AND METHODS
A physical exam, blood pressure measurement, chest radiographs, and echocardiography were performed.
RESULTS
A systolic murmur was audible in 39/122 cats. A difference between cats with and without a murmur was found for age (P=0.0001), interventricular basal septal thickness (BIVSd) (P=0.004), AoSA (P=0.003), aortic (P<0.0001), and pulmonic (P=0.021) flow velocity, the presence of IBSH (P<0.0001), and systolic anterior motion of the mitral valve (P=0.0002). More than 50% of cats with a murmur had an AoSA ≤122°. Less than 25% of the cats with an AoSA ≥137° had a murmur. The AoSA narrowed 0.55°/year of age (P<0.001), whereas the BIVSd increased 0.11 mm/year of age (P<0.0001); the BIVSd increased as the AoSA narrowed. In all cats with AoSA < 120°, IBSH was present.
CONCLUSIONS
This study demonstrates that the probability of having a systolic murmur in cats is increased by the presence of a narrow AoSA. Aging was associated with a narrower AoSA and a thicker basal septum; these findings might represent an age-related heart remodeling.
Topics: Humans; Cats; Animals; Systolic Murmurs; Echocardiography; Heart Murmurs; Ventricular Septum; Hypertrophy; Cat Diseases
PubMed: 37037177
DOI: 10.1016/j.jvc.2023.03.002 -
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 -
The Yale Journal of Biology and Medicine 1980Feline and canine cardiomyopathies (primary myocardial diseases) were reviewed and divided into three groups based on the clinical, hemodynamic, angiocardiographic, and... (Review)
Review
Feline and canine cardiomyopathies (primary myocardial diseases) were reviewed and divided into three groups based on the clinical, hemodynamic, angiocardiographic, and pathologic findings: (1) feline and canine hypertrophic cardiomyopathy, (2) feline and canine congestive (dilated) cardiomyopathy, and (3) feline restrictive cardiomyopathy. All three groups consisted predominantly of mature adult male cats and dogs. Cardiomyopathy in the hamster and turkey was also reviewed. The most common presenting signs were dyspnea and/or thromboembolism in the cat, systolic murmurs with gallop rhythms on auscultation, cardiomegaly with (groups 1 and 3) or without (group 2) pulmonary edema, abnormal electrocardiograms, elevated left ventricular end-diastolic pressures, and angiocardiographic evidence of mitral regurgitation with left ventricular concentric hypertrophy (group 1), left ventricular dilatation (group 2), or midventricular stenosis (group 3). Some cats in groups 1 and 3 also had evidence of left ventricular outflow obstruction. The principal pathologic findings in all of the cats and dogs were left atrial dilation, hypertrophy, increased septal:left ventricular free wall thickness ratio with disorganization of cardiac muscle cells (group 1); dilatation of the four chambers with degeneration of cardiac muscle cells (group 2); and extensive endocardial fibrosis and adhesion of the left ventricle (group 3). Aortic thromboembolism was commonly observed in the cats of all three groups. These clinical and pathologic findings indicate that cardiomyopathy in the cat or dog is similar to the three forms of cardiomyopathy in humans (hypertrophic, congestive, and restrictive).
Topics: Animals; Blood Pressure; Cardiomegaly; Cardiomyopathy, Hypertrophic; Cat Diseases; Cats; Coronary Angiography; Cricetinae; Disease Models, Animal; Dog Diseases; Dogs; Electrocardiography; Female; Haplorhini; Heart Failure; Male; Monkey Diseases; Myocardium; Poultry Diseases; Rodent Diseases; Thromboembolism; Turkeys
PubMed: 6447412
DOI: No ID Found -
Scientific Reports Mar 2022The hemodynamic consequences of aging have been extensively investigated during maximal incremental exercise. However, less is known about the effects of aging on...
The hemodynamic consequences of aging have been extensively investigated during maximal incremental exercise. However, less is known about the effects of aging on hemodynamics during submaximal steady-state exercise. The aim of the present investigation was to compare the hemodynamics of healthy elderly and young subjects during an exercise bout conducted at the gas threshold (GET) intensity. Two groups of healthy, physically active subjects were studied: the elderly group-EG (n = 11; > 60 years old) and the young group-YG (n = 13; < 35 years old). Both groups performed a 5-min rectangular exercise test at the GET intensity. Hemodynamics were measured using echocardiography. The main finding was that stroke volume responses were higher in the YG than the EG (72.5 ± 16.7 vs. 52.4 ± 8.4 ml, respectively). The increased stroke volume capacity in the YG was the consequence of a greater capacity to increase cardiac preload and contractility and, to a lesser extent, to reduce systemic vascular resistance. Importantly, the atrial contribution to ventricular diastolic filling was substantially higher in the YG when compared to the EG.
Topics: Adult; Aged; Cardiac Output; Diastole; Exercise; Hemodynamics; Humans; Middle Aged; Stroke Volume; Systolic Murmurs
PubMed: 35264702
DOI: 10.1038/s41598-022-07933-7 -
British Heart Journal Jul 1976A survey was conducted on 12 050 Black schoolchildren, aged 2 to 18 years, in the South Western Townships of Johannesburg (Soweto), and the prevalence of non-ejection...
A survey was conducted on 12 050 Black schoolchildren, aged 2 to 18 years, in the South Western Townships of Johannesburg (Soweto), and the prevalence of non-ejection systolic clicks and late systolic murmurs was determined. One or both of these auscultatory findings were detected in 168 children, yielding a prevalence rate of 13-99 per 1000 in the school population. A female preponderance of 1-9:1 was present and there was a strong linear increase in prevalence with age, with a peak rate of 29-41 per 1000 in 17-year-old children. A non-ejection click was the only abnormal auscultatory finding in 123 children (73%) and a mitral systolic murmur in 8 (5%), whereas in 37 (22%) both these findings were present. Of the latter 37 children, the murmur was late systolic in 32; in 5 it was early systolic. Auscultation in different postures was important in the detection of both non-ejection clicks and mitral systolic murmurs. Experience in the detection of these auscultatory findings influenced the frequency with which they were heard. Electrocardiographic abnormalities compatible with those previously described in the billowing mitral leaflet syndrome were present in 11 of 158 children. The aetiology of these auscultatory findings in this community remains unknown. In the same survey, a high prevalence rate of rheumatic heart disease was recorded and the epidemiology of the non-ejection clicks and these mitral systolic murmurs showed similarties to that of rheumatic heart disease. Though the specific billowing mitral leaflet syndrome almost certainly accounts for some of these auscultatory findings, a significant proportion may have early rheumatic heart disease. Further elucidation of this problem is necessary.
Topics: Adolescent; Age Factors; Black People; Child; Child, Preschool; Female; Heart Auscultation; Heart Murmurs; Heart Sounds; Humans; Male; Mitral Valve Insufficiency; Posture; Rheumatic Heart Disease; Sex Factors; South Africa
PubMed: 973897
DOI: 10.1136/hrt.38.7.718 -
Swiss Medical Weekly Aug 2008Auscultation has long been an important part of the evaluation of patients with known and suspected cardiac disease. The subsequent development of phonocardiography... (Review)
Review
Auscultation has long been an important part of the evaluation of patients with known and suspected cardiac disease. The subsequent development of phonocardiography provided an analogue visual display that permitted a more detailed analysis of the timing and acoustical characteristics of heart sounds, murmurs, clicks and rubs. In addition, the measurement of systolic time intervals enabled a valuable non-invasive assessment of left ventricular function. Acoustic cardiography, a much more recently developed technology, has enabled the simultaneous acquisition of ECG and cardiac acoustical data. This user-friendly and cost-effective technology permits acquisition of detailed information regarding systolic and diastolic left ventricular function and provides both a computerized interpretation and a visual display of the findings. Its clinical applications include the evaluation of patients with suspected heart failure, ischaemia and cardiac arrhythmias and the optimization of cardiovascular drug and device therapies. It can also be used in a wide variety of ambulatory and inpatient monitoring applications.
Topics: Arrhythmias, Cardiac; Auscultation; Electrocardiography; Heart Diseases; Heart Failure; Heart Murmurs; Heart Sounds; History, 20th Century; History, 21st Century; Humans; Mass Screening; Myocardial Ischemia; Phonocardiography; Ultrasonics; Ultrasonography
PubMed: 18690557
DOI: 10.4414/smw.2008.12308 -
Canadian Family Physician Medecin de... Feb 2003To compare cardiac physical examination with echocardiography for evaluating systolic murmurs. (Comparative Study)
Comparative Study Review
OBJECTIVE
To compare cardiac physical examination with echocardiography for evaluating systolic murmurs.
QUALITY OF EVIDENCE
Three databases were searched for studies comparing echocardiography and auscultation as to sensitivity and diagnostic accuracy: MEDLINE (Ovid Online), EMBASE, and Current Contexts. The quality of reported data is lowered by subjective interpretation of results of both cardiac physical examination and echocardiography, especially Doppler colour flow imaging.
MAIN MESSAGE
In adults, functional systolic murmurs can usually be distinguished from organic murmurs. Pathologic murmurs frequently have one or more associated clinical abnormalities. If a clinician determines a murmur is benign, results of echocardiography are very likely to be normal, especially in young and middle-aged adults. According to current guidelines, echocardiography should not be ordered for "innocent" systolic murmurs in patients who are asymptomatic and have otherwise normal findings on examination. If patients with functional systolic murmurs could be identified and not routinely referred for echocardiography, great cost savings could be realized.
CONCLUSION
Echocardiography is not required for all patients with systolic murmurs and should not replace cardiac physical examination.
Topics: Adult; Echocardiography; Echocardiography, Doppler, Color; Family Practice; Heart Auscultation; Heart Murmurs; Humans; Middle Aged; Sensitivity and Specificity; Systole
PubMed: 12619738
DOI: No ID Found -
Journal of Veterinary Cardiology : the... Aug 2017To assess the prevalence of functional ejection murmurs and murmurs of mitral regurgitation (MR) due to myxomatous mitral valve disease in healthy whippets; to assess...
OBJECTIVES
To assess the prevalence of functional ejection murmurs and murmurs of mitral regurgitation (MR) due to myxomatous mitral valve disease in healthy whippets; to assess the diagnostic value of auscultation to detect MR; and investigate the relationship between age and presence of echocardiographically documented MR (MR).
ANIMALS
A total of 200 healthy client-owned Whippets, recruited at national shows between 2005 and 2009 were involved in this study.
METHODS
Cross-sectional study. Dogs were examined by auscultation by one examiner and Doppler echocardiography by another, and results were compared. Prevalence of types of murmurs and MR were calculated and correlated to age. Accuracy of auscultation to predict MR was calculated.
RESULTS
Left-sided systolic heart murmurs were detected in 185/200 (93%) of dogs. Left apical systolic murmurs (L) were detected in 57/200 (29%) and left basilar systolic murmurs (L) in 128/200 of the dogs (64%). MR was present in 76/200 (38%) dogs. Prevalence MR was correlated with age (r = 0.96, p=0.0028). Mitral regurgitation detected by echocardiography was present in 12/78 (15%) of the dogs ≤ 2 years of age and in 59% of the dogs at 7-8 years old. Detection of L predicted MR with sensitivity 65%, specificity 94%, positive predictive value 86%, and negative predictive value 81%; and accuracy improved when only dogs with more intense L (grade ≥ 3/6) were considered.
CONCLUSIONS
Systolic murmurs are common in North American Whippets and this breed exhibits a high prevalence of MR, which may be documented at a relatively early age. Whippets with non-clinical MR may not be identifiable by auscultation alone; echocardiographic examination may be required to exclude a diagnosis of MR. Louder heart murmurs allow more accurate localization in this population.
Topics: Animals; Cross-Sectional Studies; Dog Diseases; Dogs; Echocardiography; Female; Heart Murmurs; Male; Mitral Valve; Mitral Valve Insufficiency; Prevalence; United States
PubMed: 28666945
DOI: 10.1016/j.jvc.2017.04.004 -
Congestive Heart Failure (Greenwich,... 2006Acoustic cardiography is an exciting, new, easy-to-use, modernized technology that incorporates already proven techniques of phonocardiography. Application of acoustic... (Review)
Review
Acoustic cardiography is an exciting, new, easy-to-use, modernized technology that incorporates already proven techniques of phonocardiography. Application of acoustic cardiography to clinical practice can improve diagnosis and management of heart failure patients. Its clinical use should help address some of the need for robust, inexpensive, and widely accessible technology for proactive heart failure diagnosis and management. Acoustic cardiographically recorded measurements have been correlated with both cardiac catheterization and echocardiographically determined hemodynamic parameters. Heart sounds captured by acoustic cardiograms have proven to assist clinicians in assessing dyspneic patients in the emergency department by utilizing the strong specificity of an S3 for detecting acute decompensated heart failure. Acoustic cardiography offers a cost-efficient, easy-to-use method to optimize the devices used in cardiac resyncronization therapy. The rapidly and easily obtainable information gathered by acoustic cardiography should foster its more widespread use in diagnosis and treatment of heart failure, including cardiac resyncronization therapy device optimization.
Topics: Auscultation; Echocardiography; Electrocardiography; Female; Heart Failure, Systolic; Heart Murmurs; Heart Sounds; Humans; Male; Phonocardiography; Sensitivity and Specificity; Systole
PubMed: 16894267
DOI: 10.1111/j.0889-7204.2006.05766.x -
American Family Physician Aug 1999Many normal children have heart murmurs, but most children do not have heart disease. An appropriate history and a properly conducted physical examination can identify... (Review)
Review
Many normal children have heart murmurs, but most children do not have heart disease. An appropriate history and a properly conducted physical examination can identify children at increased risk for significant heart disease. Pathologic causes of systolic murmurs include atrial and ventricular septal defects, pulmonary or aortic outflow tract abnormalities, and patent ductus arteriosus. An atrial septal defect is often confused with a functional murmur, but the conditions can usually be differentiated based on specific physical findings. Characteristics of pathologic murmurs include a sound level of grade 3 or louder, a diastolic murmur or an increase in intensity when the patient is standing. Most children with any of these findings should be referred to a pediatric cardiologist.
Topics: Auscultation; Child; Child, Preschool; Heart Murmurs; Humans; Palpation; Patient Education as Topic; Referral and Consultation; Teaching Materials
PubMed: 10465230
DOI: No ID Found