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British Heart Journal Mar 1968
Topics: Adolescent; Adult; Angiocardiography; Child; Child, Preschool; Chordae Tendineae; Cineangiography; Endocarditis; Female; Heart Auscultation; Humans; Male; Marfan Syndrome; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Phonocardiography; Postoperative Complications; Rheumatic Heart Disease
PubMed: 5642419
DOI: 10.1136/hrt.30.2.203 -
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 -
BMC Pediatrics Jun 2007More than 90% of heart murmurs in children are innocent. Frequently the skills of the first examiner are not adequate to differentiate between innocent and pathological...
BACKGROUND
More than 90% of heart murmurs in children are innocent. Frequently the skills of the first examiner are not adequate to differentiate between innocent and pathological murmurs. Our goal was to evaluate the value of a simple and low-cost phonocardiographic recording and analysis system in determining the characteristic features of heart murmurs in children and in distinguishing innocent systolic murmurs from pathological.
METHODS
The system consisting of an electronic stethoscope and a multimedia laptop computer was used for the recording, monitoring and analysis of auscultation findings. The recorded sounds were examined graphically and numerically using combined phono-spectrograms. The data consisted of heart sound recordings from 807 pediatric patients, including 88 normal cases without any murmur, 447 innocent murmurs and 272 pathological murmurs. The phono-spectrographic features of heart murmurs were examined visually and numerically. From this database, 50 innocent vibratory murmurs, 25 innocent ejection murmurs and 50 easily confusable, mildly pathological systolic murmurs were selected to test whether quantitative phono-spectrographic analysis could be used as an accurate screening tool for systolic heart murmurs in children.
RESULTS
The phono-spectrograms of the most common innocent and pathological murmurs were presented as examples of the whole data set. Typically, innocent murmurs had lower frequencies (below 200 Hz) and a frequency spectrum with a more harmonic structure than pathological cases. Quantitative analysis revealed no significant differences in the duration of S1 and S2 or loudness of systolic murmurs between the pathological and physiological systolic murmurs. However, the pathological murmurs included both lower and higher frequencies than the physiological ones (p < 0.001 for both low and high frequency limits). If the systolic murmur contained intensive frequency components of over 200 Hz, or its length accounted for over 80 % of the whole systolic duration, it was considered pathological. Using these criteria, 90 % specificity and 91 % sensitivity in screening were achieved.
CONCLUSION
Phono-spectrographic analysis improves the accuracy of primary heart murmur evaluation and educates inexperienced listener. Using simple quantitative criterias a level of pediatric cardiologist is easily achieved in screening heart murmurs in children.
Topics: Adolescent; Child; Child, Preschool; Diagnosis, Differential; Heart Murmurs; Humans; Infant; Infant, Newborn; Phonocardiography; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Sound Spectrography
PubMed: 17559690
DOI: 10.1186/1471-2431-7-23 -
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 -
Clinical Cardiology May 1984From 1971-1981, 18 patients with discrete subaortic stenosis were treated surgically at the Medical University of South Carolina. Echocardiography was diagnostic in 10...
From 1971-1981, 18 patients with discrete subaortic stenosis were treated surgically at the Medical University of South Carolina. Echocardiography was diagnostic in 10 of 11 patients in whom it was used. Preoperative cardiac catheterization was performed in all patients. The preoperative left ventricular outflow systolic pressure gradient was 82.0 +/- 27.2 mmHg (mean +/- SD) (range 30-145). In 16 (88.8%) patients excision of the subaortic membrane was complete, and relief of left ventricular outflow obstruction was good. The excision was incomplete in 2 patients; one required reoperation for residual gradient and developed complete heart block, and the other had a residual gradient of 60 mmHg and was in New York Heart Association functional class II when lost to follow-up. These data suggest that complete excision of the discrete subaortic stenosis is important to achieve good relief of left ventricular outflow obstruction.
Topics: Adolescent; Aortic Stenosis, Subvalvular; Blood Pressure; Cardiomyopathy, Hypertrophic; Child; Child, Preschool; Echocardiography; Female; Heart Murmurs; Humans; Infant; Male
PubMed: 6538823
DOI: 10.1002/clc.4960070507 -
Journal of the American Veterinary... Jun 2009To determine the prevalence of cardiomyopathy and the relationship between cardiomyopathy and heart murmurs in apparently healthy cats.
OBJECTIVE
To determine the prevalence of cardiomyopathy and the relationship between cardiomyopathy and heart murmurs in apparently healthy cats.
DESIGN
Cross-sectional study.
ANIMALS
103 privately owned, apparently healthy domestic cats.
PROCEDURES
Cats were physically and echocardiographically examined by 2 investigators independently. Left ventricular wall thickness was determined via 2-dimensional echocardiography in short-axis and long-axis planes. Left ventricular hypertrophy was identified when end-diastolic measurements of the interventricular septum or posterior wall were > or = 6 mm. Cats with left ventricular hypertrophy but without left ventricular dilatation were considered to have hypertrophic cardiomyopathy (HCM). The associations between heart murmurs and Doppler echocardiographic velocity profiles indicative of dynamic ventricular outflow tract obstruction were evaluated.
RESULTS
Heart murmurs were detected in 16 (15.5%; 95% confidence interval, 9.2% to 24.0%) cats; of these, 5 had cardiomyopathy. Cardiomyopathy was also identified in 16 (15.5%; 95% confidence interval, 9.2% to 24.0%) cats; 15 had HCM, and 1 had arrhythmogenic right ventricular cardiomyopathy. Of the cats with HCM, 11 had segmental left ventricular hypertrophy, 3 had diffuse left ventricular hypertrophy, and 1 had borderline left ventricular hypertrophy with marked systolic anterior motion of the mitral valve. Sensitivity and specificity of auscultatory detection of a heart murmur for diagnosing cardiomyopathy were 31% and 87%, respectively. Echocardiographic evidence of late systolic acceleration within ventricular outflow tracts was associated with the existence of a heart murmur.
CONCLUSIONS AND CLINICAL RELEVANCE
Cardiomyopathy was common in the healthy cats evaluated in this study. In apparently healthy cats, detection of a heart murmur is not a reliable indicator of cardiomyopathy.
Topics: Animals; Cardiomyopathies; Cat Diseases; Cats; Echocardiography; Female; Heart Murmurs; Male; Prevalence
PubMed: 19480619
DOI: 10.2460/javma.234.11.1398 -
Journal of Veterinary Internal Medicine 2001The ability of clinicians, ie, 10 veterinary students, 10 general practitioners, and 10 board certified internists, to describe and interpret common normal and abnormal...
The ability of clinicians, ie, 10 veterinary students, 10 general practitioners, and 10 board certified internists, to describe and interpret common normal and abnormal heart sounds was assessed. Recordings of heart sounds from 7 horses with a variety of normal and abnormal rhythms, heart sounds, and murmurs were analyzed by digital sonography. The perception of the presence or absence of the heart sounds S1, S2, and S4 was similar for clinicians irrespective of their level of training and was in agreement with the sonographic interpretation on 89, 82, and 78% of occasions, respectively. However, practitioners were less likely to correctly describe the presence of S3. The heart rhythm was correctly described as being regular or irregular on 89% of occasions, and this outcome was not affected by level of training. Differentiation of the type of irregularity was less reliable. The perception of the intensity of a heart murmur was accurate and correlated with the grade assigned in the living horses, R2 = .68, and with sonographic measurements of the murmur's intensity, R2 = .69. Clinicians overestimated the duration of cardiac murmurs, particularly that of the loud systolic murmur. Only diplomates could reliably differentiate systolic from diastolic murmurs. The ability to diagnose the underlying cardiac problem was significantly affected by training; diplomates, practitioners, and undergraduates made the correct diagnosis on 53, 33, and 29% of occasions, respectively. The poor diagnostic ability of practitioners and the lack of improvement in diagnostic skill after the 2nd year of veterinary school emphasizes the need for better teaching of these skills. Digital sonograms that combine sound files with synchronous visual interpretations may be useful in this regard.
Topics: Adult; Animals; Arrhythmias, Cardiac; Diagnosis, Differential; Education, Veterinary; Heart Auscultation; Heart Murmurs; Horse Diseases; Horses; Humans; Middle Aged; Observer Variation; Professional Competence; Veterinary Medicine
PubMed: 11817055
DOI: 10.1892/0891-6640(2001)015<0507:aaotao>2.3.co;2 -
Journal of Veterinary Internal Medicine 2006Nineteen of 28 (67%) Greyhounds enrolled in the Blood Donor Program at The Veterinary Teaching Hospital, The Ohio State University (Columbus, OH), had a left basilar...
Nineteen of 28 (67%) Greyhounds enrolled in the Blood Donor Program at The Veterinary Teaching Hospital, The Ohio State University (Columbus, OH), had a left basilar systolic murmur. Ten Greyhounds with murmurs and 9 without murmurs were evaluated to gain knowledge about the pathogenesis of this murmur. Echocardiograms were performed without sedation by means of a GE Vivid 7 Echocardiographic System with a continuous ECG; systolic arterial blood pressure (SABP) was measured with an Ultrasonic Doppler Flow detector model 811-B. The mean peak aortic velocity in the Greyhounds with murmurs (2.15 m/s; range, 1.8-2.2 m/s) was significantly higher than in the Greyhounds without murmurs (1.89 m/s; range, 1.6-2.0 m/s) (P < .001); there were no significant differences between groups for aortic valve or annulus diameter, fractional shortening, pulmonic velocity, SABP, hematocrit, serum protein concentration, or red blood cell counts. In this study, Greyhounds with soft, left basilar systolic murmurs had mildly (but significantly) higher mean peak aortic velocities than similar dogs without murmurs. In the dogs with murmurs (and higher velocities), we could not identify structural abnormalities, such as valvular lesions or other congenital defects. There was no inverse correlation between the systolic murmur and the higher hematocrit and red blood cell counts observed in this breed. This 1-2/6 basilar systolic murmur is common in Greyhounds, and it does not appear to be of any clinical consequence.
Topics: Animals; Blood Flow Velocity; Dog Diseases; Dogs; Echocardiography; Female; Heart; Heart Murmurs; Heart Sounds; Male
PubMed: 16496926
DOI: 10.1892/0891-6640(2006)20[78:lbsmir]2.0.co;2 -
Cardiology Research Jun 2017We report a 42-year-old female who was admitted for abdominal pain, and also endorsed dyspnea, fatigue and chronic palpitations. Past medical history included asthma,...
We report a 42-year-old female who was admitted for abdominal pain, and also endorsed dyspnea, fatigue and chronic palpitations. Past medical history included asthma, patent ductus arteriosus repaired in childhood and ill-defined thyroid disease. Physical examination revealed blood pressure of 136/88 mm Hg and heart rate of 149 beats per minute. Cardiovascular exam revealed an irregularly irregular rhythm, and pulmonary exam revealed mild expiratory wheezing. Abdomen was tender. Electrocardiogram revealed atrial fibrillation with rapid ventricular response which responded to intravenous diltiazem. Labs revealed TSH of < 0.1 mU/L and free T4 of 2.82 ng/dL, a positive TSH-receptor and thyroid peroxidase antibodies suggesting Grave's thyrotoxicosis. A transthoracic echocardiogram reported an ejection fraction of 55-60%, with mild to moderate mitral regurgitation (MR) and moderate to severe tricuspid regurgitation (TR) and dilated right heart chambers. Pulmonary artery systolic pressure was 52 mm Hg. Transesophageal echocardiogram revealed a myxomatous tricuspid valve with thickening and malcoaptation of the leaflets and moderate to severe TR, mild to moderate MR with mild thickening of the mitral valve leaflets. Abdominal ultrasound revealed wall thickening of the gall bladder concerning for acute cholecystitis. She underwent laparoscopic cholecystectomy and was discharged in stable condition on methimazole for her thyroid disease, and on oral diltiazem for rate control and anticoagulation for atrial fibrillation. Follow-up visit with her cardiologist few months later documented absence of cardiac symptoms, and no murmurs were reported on physical examination. This case underscores the importance of maintaining a high index of suspicion for hyperthyroidism when faced with significant newly diagnosed pulmonary hypertension and TR, as treatment of the thyroid abnormalities can reverse these cardiac findings.
PubMed: 28725332
DOI: 10.14740/cr564w -
British Heart Journal Sep 1991The origin of innocent systolic murmurs is uncertain. This study was designed to evaluate the relative contribution in the same subjects of the main factors implicated...
OBJECTIVE
The origin of innocent systolic murmurs is uncertain. This study was designed to evaluate the relative contribution in the same subjects of the main factors implicated in the genesis of vibratory innocent systolic murmurs--that is, the presence of left ventricular bands and increased left ventricular flow indices--and to examine evidence for turbulence in relation to these findings.
PATIENTS
40 children with innocent systolic murmurs and 40 paired controls without murmurs were matched for age and body surface area.
DESIGN
These subjects were examined prospectively by cross sectional echocardiography with pulsed and continuous wave Doppler and colour flow mapping.
SETTING
A tertiary referral centre for paediatric cardiology.
RESULTS
Left ventricular bands were significantly more prevalent in patients with innocent murmurs (70%) than in controls (48%) but only if apical bands were included (p = 0.039). Cases had significantly higher aortic peak flow velocities (p less than 0.001), flow integrals (p = 0.001), and stroke volumes (p = 0.014), and significantly lower heart rates (p = 0.033) than controls. There were no significant differences between cases and controls in mean aortic diameter, cardiac output, or ejection fraction. There was no evidence of turbulence in the left ventricle or outflow tract in any individual but curvilinear periodic vibrations and audible "whoops" were detected in the left ventricle by pulsed wave Doppler echocardiography. These were significantly more common in cases than controls (p less than 0.01) but were not related to the presence of bands.
CONCLUSIONS
Innocent systolic murmurs were unrelated to aortic size but they were strongly associated with higher aortic flow volume and velocity, with relative bradycardia, and with evidence of vibratory phenomena in the left ventricle. The role of left ventricular bands remains uncertain.
Topics: Adolescent; Child; Child, Preschool; Echocardiography, Doppler; Heart Murmurs; Heart Ventricles; Humans; Infant; Prospective Studies; Systole
PubMed: 1931348
DOI: 10.1136/hrt.66.3.217