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Journal of Veterinary Internal Medicine Jan 2017Mean systolic blood pressure in apparently healthy cats has been reported as approximately 125 mmHg using direct assessment, but there is greater variability in reported...
BACKGROUND
Mean systolic blood pressure in apparently healthy cats has been reported as approximately 125 mmHg using direct assessment, but there is greater variability in reported values using indirect assessment. Increasing age and the white-coat effect are associated with increased systolic blood pressure.
HYPOTHESIS/OBJECTIVES
To report Doppler-derived blood pressure measurements from a large population of apparently healthy cats and to assess epidemiologic factors associated with recorded blood pressures.
ANIMALS
A total of 780 cats in rehoming centers enrolled in a screening program for heart murmurs and cardiac disease.
METHODS
Cats were considered healthy based on history and physical examination. Cats with known hypertension, hyperthyroidism, or clinical signs of systemic disease and pregnant or nursing queens were excluded. After an acclimatization period, systolic blood pressure was measured using the Doppler sphygmomanometry method following the recommendations of the ACVIM Consensus Statement. General linear model analysis was performed to identify factors associated with variation in systolic blood pressure.
RESULTS
Median (interquartile range, IQR) systolic blood pressure for the group was 120.6 (110.4-132.4) mmHg. Factors significantly associated with higher systolic blood pressure in a general linear model were increased age, increased nervousness, male sex, neutering, or history of being a stray. The model explained 29.2% of the variation in systolic blood pressure.
CONCLUSIONS AND CLINICAL IMPORTANCE
The age, demeanor, sex, neuter status and history of being a stray should be taken into account when assessing systolic blood pressure in apparently healthy cats.
Topics: Animals; Blood Pressure; Cats; Female; Male; Reference Values; Systole
PubMed: 27906477
DOI: 10.1111/jvim.14625 -
PloS One 2021The Deepwater Horizon (DWH) oil spill profoundly impacted the health of bottlenose dolphins (Tursiops truncatus) in Barataria Bay, LA (BB). To comprehensively assess the...
The Deepwater Horizon (DWH) oil spill profoundly impacted the health of bottlenose dolphins (Tursiops truncatus) in Barataria Bay, LA (BB). To comprehensively assess the cardiac health of dolphins living within the DWH oil spill footprint, techniques for in-water cardiac evaluation were refined with dolphins cared for by the U.S. Navy Marine Mammal Program in 2018 and applied to free-ranging bottlenose dolphins in BB (n = 34) and Sarasota Bay, Florida (SB) (n = 19), a non-oiled reference population. Cardiac auscultation detected systolic murmurs in the majority of dolphins from both sites (88% BB, 89% SB) and echocardiography showed most of the murmurs were innocent flow murmurs attributed to elevated blood flow velocity [1]. Telemetric six-lead electrocardiography detected arrhythmias in BB dolphins (43%) and SB dolphins (31%), all of which were considered low to moderate risk for adverse cardiac events. Echocardiography showed BB dolphins had thinner left ventricular walls, with significant differences in intraventricular septum thickness at the end of diastole (p = 0.002), and left ventricular posterior wall thickness at the end of diastole (p = 0.033). BB dolphins also had smaller left atrial size (p = 0.004), higher prevalence of tricuspid valve prolapse (p = 0.003), higher prevalence of tricuspid valve thickening (p = 0.033), and higher prevalence of aortic valve thickening (p = 0.008). Two dolphins in BB were diagnosed with pulmonary arterial hypertension based on Doppler echocardiography-derived estimates and supporting echocardiographic findings. Histopathology of dolphins who stranded within the DWH oil spill footprint showed a significantly higher prevalence of myocardial fibrosis (p = 0.003), regardless of age, compared to dolphins outside the oil spill footprint. In conclusion, there were substantial cardiac abnormalities identified in BB dolphins which may be related to DWH oil exposure, however, future work is needed to rule out other hypotheses and further elucidate the connection between oil exposure, pulmonary disease, and the observed cardiac abnormalities.
Topics: Animals; Bottle-Nosed Dolphin; Echocardiography; Electrocardiography; Fibrosis; Heart; Heart Injuries; Hypertension; Petroleum Pollution
PubMed: 34905585
DOI: 10.1371/journal.pone.0261112 -
Biomedical Engineering Online Aug 2012Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct...
BACKGROUND
Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians) may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respiratory sounds from a remote auscultation, as well as video images showing where the technician is placing the stethoscope on the patient's body.
METHODS
A real-time wireless stethoscopy system was designed. The initial requirements were: 1) The system must send audio and video synchronously over IP networks, not requiring an Internet connection; 2) It must preserve the quality of cardiorespiratory sounds, allowing to adapt the binaural pieces and the chestpiece of standard stethoscopes, and; 3) Cardiorespiratory sounds should be recordable at both sides of the communication. In order to verify the diagnostic capacity of the system, a clinical validation with eight specialists has been designed. In a preliminary test, twelve patients have been auscultated by all the physicians using the tele-stethoscopy system, versus a local auscultation using traditional stethoscope. The system must allow listen the cardiac (systolic and diastolic murmurs, gallop sound, arrhythmias) and respiratory (rhonchi, rales and crepitations, wheeze, diminished and bronchial breath sounds, pleural friction rub) sounds.
RESULTS
The design, development and initial validation of the real-time wireless tele-stethoscopy system are described in detail. The system was conceived from scratch as open-source, low-cost and designed in such a way that many universities and small local companies in developing countries may manufacture it. Only free open-source software has been used in order to minimize manufacturing costs and look for alliances to support its improvement and adaptation. The microcontroller firmware code, the computer software code and the PCB schematics are available for free download in a subversion repository hosted in SourceForge.
CONCLUSIONS
It has been shown that real-time tele-stethoscopy, together with a videoconference system that allows a remote specialist to oversee the auscultation, may be a very helpful tool in rural areas of developing countries.
Topics: Electric Power Supplies; Reproducibility of Results; Rural Population; Software; Stethoscopes; Telemedicine; Time Factors; Wireless Technology
PubMed: 22917062
DOI: 10.1186/1475-925X-11-57 -
Animals : An Open Access Journal From... Aug 2022The ductus arteriosus (DA) and foramen ovale (FO), including the septum primum (SP) and septum secundum (SS), are important structures in fetal circulation and are...
The ductus arteriosus (DA) and foramen ovale (FO), including the septum primum (SP) and septum secundum (SS), are important structures in fetal circulation and are unexplored in neonatal equids. The objective of this study is to describe echocardiographic characteristics in a hospital-based population of neonatal foals. On days 2, 5 and 10 after parturition, cardiac ultrasound was performed, and clinical data were collected in healthy and diseased Warmblood foals. Fifty healthy ( = 15) and diseased ( = 35) Warmblood foals were examined. A left-sided and right-sided holosystolic murmur was audible in 98% ( = 42) and 51% ( = 22), respectively, on day 2; in 81% ( = 25) and 19% ( = 6) on day 5; and in 44% ( = 4) and 11% ( = 1) on day 10. The median grade of the systolic murmurs was higher when the DA was open. Flow through the DA could be visualized with color flow and continuous wave (CW) Doppler from the left parasternal long-axis view of the pulmonary artery in 40/43 foals on day 2, 9/31 foals on day 5 and 2/9 foals on day 10. The DA diameter was 2 ± 1 mm on day 2, 2 ± 1 mm on day 5 and 1 mm on day 10. The thickness of both septa of the FO was similar. The SP fluttered into the left atrium at all ages, but the maximal distance between the SP and SS decreased over time. In conclusion, cardiac murmurs, a patent DA and fluttering FO are frequent findings in neonatal foals. While these findings are probably physiological, the clinical importance needs to be further elucidated.
PubMed: 36077962
DOI: 10.3390/ani12172242 -
BMC Medical Education Jul 2022Well performed clinical communication is a cornerstone of collaborative care in medicine but may be confounded by inconsistent intentions of the messenger and biased...
BACKGROUND
Well performed clinical communication is a cornerstone of collaborative care in medicine but may be confounded by inconsistent intentions of the messenger and biased interpretation by the recipient. A comparison of the findings of electronic echocardiography reports with clinician-completed standardised request forms provided an opportunity to assess communication quality.
AIM
The study aimed to determine clinician aptitude to complete written echocardiography referral forms by assessing the completeness, appropriateness, accuracy, and coherency of the reported clinical findings, conclusions and requests made on the referral forms. The study explored factors that may influence the quality of communication through this referral medium.
METHODS
A retrospective cohort study was conducted on patients who underwent trans-thoracic echocardiography imaging at Cecilia Makiwane Hospital in East London over 26 months. Paper echocardiography request forms that recorded the requesting clinician's findings on examination, the provisional clinical diagnosis, and the specific echocardiographic information sought, were compared with the actual findings on echocardiography.
RESULTS
Of 613 request forms reviewed, 97 cases were excluded due to illegibility or because they lacked analysable information or requester details, leaving 516 forms suitable for study. No pathology was found on echocardiography in 31%. Of the murmurs expected from the echocardiography findings, only half were recorded on the request form (sensitivity and positive predictive value both 52%.). Only 35% of request forms that mentioned a mitral systolic murmur gave a working diagnosis of mitral regurgitation and only 38% of request forms that mentioned an aortic systolic murmur considered aortic stenosis. Clinically suspected cardiomyopathy (CMO) had a PPV of 43% and echocardiographic CMO was missed clinically in 41%. Apex beat displacement reported clinically was not associated with echocardiographic LV dilatation in 65% of cases. One-third (34%) of forms reporting murmurs did not request valve function assessment and 17% considering cardiomyopathy did not request left ventricular function assessment.
CONCLUSION
Echocardiography request forms highlight vulnerabilities in clinical communication. Specifically, important clinical features were missing and more concerningly, included when unlikely to be present. There was a lack of concordance between recorded clinical findings and postulated diagnoses. Clinicians sometimes appeared unclear about the value or appropriateness of the requested assistance. Greater emphasis on teaching examination and communication skills may foster safer and more efficient use of scarce resources.
Topics: Cardiomyopathies; Communication; Echocardiography; Heart Murmurs; Humans; Referral and Consultation; Retrospective Studies; Systolic Murmurs
PubMed: 35831886
DOI: 10.1186/s12909-022-03602-5 -
The Journal of Veterinary Medical... Sep 2023A 1-month-old crossbred calf was referred for examination due to marked systolic heart murmurs and poor growth. The heart murmur was most audible on the right side of...
A 1-month-old crossbred calf was referred for examination due to marked systolic heart murmurs and poor growth. The heart murmur was most audible on the right side of the cranial thorax. Cardiomegaly was evident on chest radiography, and echocardiography demonstrated aortic regurgitation and decreased fractional shortening. Cardiomegaly, aortic root dilation and cardiac displacement were confirmed by computed tomography. At necropsy, the heart was enlarged, and all three aortic valve leaflets were irregularly shaped. In calves with chronic aortic insufficiency, remodeling displacement of the heart and aorta causes changes in the location and timing of heart murmurs. Therefore, aortic insufficiency cannot be ruled out when a systolic heart murmur can be observed in the right chest wall.
Topics: Animals; Cattle; Aortic Valve Insufficiency; Aortic Valve; Heart Murmurs; Echocardiography; Cardiomegaly; Cattle Diseases
PubMed: 37532587
DOI: 10.1292/jvms.23-0139 -
Journal of Clinical and Translational... Feb 2023Alagille syndrome (AGS) is an autosomal dominant multisystem disorder caused by mutations in the and genes. AGS has been rarely reported in adult patients, mainly...
BACKGROUND AND AIMS
Alagille syndrome (AGS) is an autosomal dominant multisystem disorder caused by mutations in the and genes. AGS has been rarely reported in adult patients, mainly because its characteristics in adults are subtle. The study aimed to improve the understanding of adult AGS by a descriptive case series.
METHODS
Eight adults diagnosed with AGS at our hospital between June 2016 and June 2019 were included in the study. Clinical data, biochemical results, imaging results, liver histopathology, and genetic testing were analyzed.
RESULTS
Three female and five male patients with a median age of 24.5 years at the time of diagnosis were included in the analysis. The clinical manifestations were adult-onset (62.5%, 5/8), cholestasis (50%, 4/8), butterfly vertebrae (62.5%, 5/8), systolic murmurs (12.5%, 1/8), typical facies (12.5%, 1/8), posterior embryotoxon, and renal abnormalities (0/8). Genetic sequencing showed that all patients had mutations, with four occurring in the gene and four in the gene. Six were substitution mutations, one was a deletion mutation, and one was a splicing mutation. Five had been previously reported; but the others, one mutation and two mutations were unique and are reported here for the first time.
CONCLUSIONS
The clinical manifestations highlighted by the current diagnostic criteria for most adults with AGS are atypical. Those who do not meet the criteria but are highly suspicious of having AGS need further evaluation, especially genetic testing.
PubMed: 36406308
DOI: 10.14218/JCTH.2021.00313 -
American Family Physician Jun 2000Mitral valve prolapse is a pathologic anatomic and physiologic abnormality of the mitral valve apparatus affecting mitral leaflet motion. "Mitral valve prolapse... (Review)
Review
Mitral valve prolapse is a pathologic anatomic and physiologic abnormality of the mitral valve apparatus affecting mitral leaflet motion. "Mitral valve prolapse syndrome" is a term often used to describe a constellation of mitral valve prolapse and associated symptoms or other physical abnormalities such as autonomic dysfunction, palpitations and pectus excavatum. The importance of recognizing that mitral valve prolapse may occur as an isolated disorder or with other coincident findings has led to the use of both terms. Mitral valve prolapse syndrome, which occurs in 3 to 6 percent of Americans, is caused by a systolic billowing of one or both mitral leaflets into the left atrium, with or without mitral regurgitation. It is often discovered during routine cardiac auscultation or when echocardiography is performed for another reason. Most patients with mitral valve prolapse are asymptomatic. Those who have symptoms commonly report chest discomfort, anxiety, fatigue and dyspnea, but whether these are actually due to mitral valve prolapse is not certain. The principal physical finding is a midsystolic click, which frequently is followed by a late systolic murmur. Although echocardiography is the most useful mode for identifying mitral valve prolapse, it is not recommended as a screening tool for mitral valve prolapse in patients who have no systolic click or murmur on careful auscultation. Mitral valve prolapse has a benign prognosis and a complication rate of 2 percent per year. The progression of mitral regurgitation may cause dilation of the left-sided heart chambers. Infective endocarditis is a potential complication. Patients with mitral valve prolapse syndrome who have murmurs and/or thickened redundant leaflets seen on echocardiography should receive antibiotic prophylaxis against endocarditis.
Topics: Diagnosis, Differential; Echocardiography; Electrocardiography; Heart Auscultation; Humans; Mitral Valve Prolapse; Patient Education as Topic; Prognosis; Teaching Materials
PubMed: 10865929
DOI: No ID Found -
JAMA Cardiology Apr 2018Hutchinson-Gilford progeria syndrome (HGPS) is an ultrarare disorder associated with premature death due to cardiovascular events during the second decade of life.... (Observational Study)
Observational Study
IMPORTANCE
Hutchinson-Gilford progeria syndrome (HGPS) is an ultrarare disorder associated with premature death due to cardiovascular events during the second decade of life. However, because of its rarity (107 identified living patients), the natural history of cardiac disease remains uncharacterized. Therefore, meaningful cardiac end points for clinical trials have been difficult to establish.
OBJECTIVE
To examine the course of appearance of cardiac abnormalities in patients with HGPS to identify meaningful cardiac end points for use in future clinical trials.
DESIGN, SETTING, AND PARTICIPANTS
In this prospective, cross-sectional, observational study, 27 consecutive patients with clinically and genetically confirmed classic HGPS were evaluated at a single center for 1 visit from July 1, 2014, through February 29, 2016, before initiation of treatment.
EXPOSURE
Classic HGPS.
MAIN OUTCOMES AND MEASURES
Echocardiography was used to assess ventricular and valve function using standard techniques. Diastolic left ventricular (LV) function was assessed using tissue Doppler imaging. Previously published normative data were used to adjust findings to age and body size.
RESULTS
This study included 27 patients (median age, 5.6 years; age range, 2-17 years; 15 [56%] male). Among echocardiographic indicators, LV diastolic dysfunction, defined as a tissue Doppler septal or lateral early velocity z score less than -2, was the most prevalent abnormality, seen in 16 patients (59%). Diastolic dysfunction was seen in all age groups, and its prevalence increased with age, mirroring findings seen during normal aging. Indicators of LV diastolic function were more abnormal in older patients. The z scores for lateral and septal early velocities were lower (r = -0.77, P < .001; and r = -0.66, P < .001, respectively), whereas those for the ratio of early mitral inflow velocity to early diastolic tissue Doppler myocardial velocity were higher (r = 0.80, P < .001; and r = 0.72, P < .001, respectively) in older patients. Other echocardiographic findings, including LV hypertrophy, LV systolic dysfunction, and valve disease, were less prevalent in the first decade and were seen more frequently in the second decade.
CONCLUSIONS AND RELEVANCE
In this largest-to-date cohort of patients with HGPS, LV diastolic dysfunction was the most prevalent echocardiographic abnormality and its prevalence increased with aging. Echocardiographic indicators of LV diastolic function may be useful end points in future clinical trials in this patient population.
Topics: Adolescent; Blood Pressure; Child; Child, Preschool; Cross-Sectional Studies; Echocardiography; Electrocardiography; Female; Heart; Heart Murmurs; Humans; Male; Myocardium; Progeria; Prospective Studies; Pulse Wave Analysis
PubMed: 29466530
DOI: 10.1001/jamacardio.2017.5235