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The Journal of Veterinary Medical... Jun 2010Seven hundreds fifty-two Standardbreds, with poor performance, underwent a thorough diagnostic protocol. In 157 out of 233 horses, with cardiac murmurs, echocardiography...
Seven hundreds fifty-two Standardbreds, with poor performance, underwent a thorough diagnostic protocol. In 157 out of 233 horses, with cardiac murmurs, echocardiography and color flow Doppler (CFD) mapping were performed. Murmur of tricuspid valve regurgitation was identified in 185 horses, while murmurs of mitral (23), aortic (9) and pulmonary (3) valve regurgitations were detected less frequently. Functional systolic, functional pre-systolic, and functional early diastolic murmurs were identified in 10, 11 and 2 horses. Two-dimensional and M-mode echocardiography showed no abnormality in 145 horses and by CFD the presence of one or more jets of valve regurgitation were observed in 149 patients. The results obtained suggest that cardiac murmurs are a common finding in Standardbreds presented with poor performance.
Topics: Animals; Aortic Valve Insufficiency; Diastole; Echocardiography; Echocardiography, Doppler, Color; Heart Murmurs; Horse Diseases; Horses; Mitral Valve Insufficiency; Physical Examination; Prevalence; Running; Systole; Tricuspid Valve Insufficiency
PubMed: 20110625
DOI: 10.1292/jvms.09-0217 -
Journal of Internal Medicine Jun 2012To determine whether a low-grade systolic murmur, found at heart auscultation, in middle-aged healthy men influences the long-term risk of aortic valve replacement (AVR)...
OBJECTIVE
To determine whether a low-grade systolic murmur, found at heart auscultation, in middle-aged healthy men influences the long-term risk of aortic valve replacement (AVR) and death from cardiovascular disease (CVD). Setting and subjects. During 1972-1975, 2014 apparently healthy men aged 40-59 years underwent an examination programme including case history, clinical examination, blood tests and a symptom-limited exercise ECG test. Heart auscultation was performed under standardized conditions, and murmurs were graded on a scale from I to VI. No men were found to have grade V/VI murmurs. Participants were followed for up to 35 years.
RESULTS
A total of 1541 men had no systolic murmur; 441 had low-grade murmurs (grade I/II) and 32 had moderate-grade murmurs (grade III/IV). Men with low-grade murmurs had a 4.7-fold [95% confidence interval (CI) 2.1-11.1] increased age-adjusted risk of AVR, but no increase in risk of CVD death. Men with moderate-grade murmurs had an 89.3-fold (95% CI 39.2-211.2) age-adjusted risk of AVR and a 1.5-fold (95% CI 0.8-2.5) age-adjusted increased risk of CVD death.
CONCLUSIONS
Low-grade systolic murmur was detected at heart auscultation in 21.9% of apparently healthy middle-aged men. Men with low-grade murmur had an increased risk of AVR, but no increase in risk of CVD death. Only 1.6% of men had moderate-grade murmur; these men had a very high risk of AVR and a 1.5-fold albeit non-significant increase in risk of CVD death.
Topics: Adult; Aortic Valve Stenosis; Cohort Studies; Follow-Up Studies; Heart Auscultation; Heart Diseases; Heart Murmurs; Heart Valve Prosthesis Implantation; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Norway; Odds Ratio; Physical Examination; Prevalence; Prognosis; Prospective Studies; Risk Factors
PubMed: 22061296
DOI: 10.1111/j.1365-2796.2011.02480.x -
California Medicine Nov 1949As a guide in distinguishing between organic and functional systolic murmurs, five characteristics of a murmur should always be noted, namely, (a) the location of...
As a guide in distinguishing between organic and functional systolic murmurs, five characteristics of a murmur should always be noted, namely, (a) the location of maximal intensity of the murmur; (b) the intensity of the murmur itself; (c) the character of the murmur, that is, whether it is blowing, rumbling, rough or harsh; (d) the transmission of the murmur; and (e) the duration of the murmur and its time within the cardiac cycle. Functional systolic murmurs may be found at any of the "valve areas," are usually faint to moderately loud, are usually soft and blowing in quality, are usually only slightly transmitted, and are usually not heard immediately following the first heart sound. In doubtful cases, those in which history and physical examination alone are not sufficient to make a diagnosis of functional systolic murmur, further studies should be undertaken to determine the presence or absence of organic heart disease. Until a diagnosis of organic heart disease can be made with reasonable certainty, there should be no restriction of activity imposed, because of the likelihood of the development of cardiac neurosis in the patient.
Topics: Child; Hearing; Heart; Heart Diseases; Heart Murmurs; Heart Sounds; Humans; Meridians; Physical Examination; Probability; Syncope; Systole; Systolic Murmurs
PubMed: 15392818
DOI: No ID Found -
British Heart Journal Sep 1968
Topics: Aged; Aorta, Thoracic; Aortic Valve; Calcinosis; Heart Auscultation; Heart Valves; Humans; Mitral Valve; Myocardium
PubMed: 5676939
DOI: 10.1136/hrt.30.5.687 -
Healthcare Technology Letters Dec 2015A robust multistage decision-based heart sound delineation (MDHSD) method is presented for automatically determining the boundaries and peaks of heart sounds (S1, S2,...
A robust multistage decision-based heart sound delineation (MDHSD) method is presented for automatically determining the boundaries and peaks of heart sounds (S1, S2, S3, and S4), systolic, and diastolic murmurs (early, mid, and late) and high-pitched sounds (HPSs) of the phonocardiogram (PCG) signal. The proposed MDHSD method consists of the Gaussian kernels based signal decomposition (GSDs) and multistage decision-based delineation (MDBD). The GSD algorithm first removes the low-frequency (LF) artefacts and then decomposes the filtered signal into two subsignals: the LF sound part (S1, S2, S3, and S4) and the high-frequency sound part (murmurs and HPSs). The MDBD algorithm consists of absolute envelope extraction, adaptive thresholding, and fiducial point determination. The accuracy and robustness of the proposed method is evaluated using various types of normal and pathological PCG signals. Results show that the method achieves an average sensitivity of 98.22%, positive predictivity of 97.46%, and overall accuracy of 95.78%. The method yields maximum average delineation errors of 4.52 and 4.14 ms for determining the start-point and end-point of sounds. The proposed multistage delineation algorithm is capable of improving the delineation accuracy under time-varying amplitudes of heart sounds and various types of murmurs. The proposed method has significant potential applications in heart sounds and murmurs classification systems.
PubMed: 26713160
DOI: 10.1049/htl.2015.0010 -
Canadian Medical Association Journal Mar 1963The diagnosis of classical mitral stenosis is easy, but many pitfalls lead to over-diagnosis or under-diagnosis. These have been considered in detail and variations in...
The diagnosis of classical mitral stenosis is easy, but many pitfalls lead to over-diagnosis or under-diagnosis. These have been considered in detail and variations in symptoms and signs have been illustrated by case histories. Such variations include: (1) Embolism producing the Leriche syndrome; (2) mitral stenosis with insignificant hemodynamic effect; (3) myxoma masquerading as mitral stenosis; (4) mitral stenosis without apical murmurs, and (5) mitral stenosis with a systolic murmur predominant or alone. In cases of combined mitral and aortic stenosis, the history, radiographic configuration, and incidence of hemoptysis, edema, bronchitis, embolism and atrial fibrillation resemble such findings in cases of isolated mitral stenosis, but the auscultatory signs of the latter may be obscured. The degree of aortic stenosis is difficult to determine in cases of combined stenosis. In the diagnosis of re-stenosis the condition of the valve at the first commissurotomy, the precise procedure performed and the degree of regurgitation produced are of prime importance. Congenital mitral stenosis is rare and is associated with a high incidence of other defects.
Topics: Aortic Valve Stenosis; Atrial Fibrillation; Embolism; Heart Murmurs; Hemodynamics; Humans; Incidence; Male; Mitral Valve Stenosis; Myxoma
PubMed: 13936649
DOI: No ID Found -
AJNR. American Journal of Neuroradiology Aug 2006Musical murmurs (MMs), sometimes called seagull cry, goose cry, honks, or cooing murmur, are murmurs with a single frequency that sounds like a musical tone. Doppler...
BACKGROUND AND PURPOSE
Musical murmurs (MMs), sometimes called seagull cry, goose cry, honks, or cooing murmur, are murmurs with a single frequency that sounds like a musical tone. Doppler detections usually show mirror-image parallel strings or bands of low to moderate frequency. Musical murmurs are mostly described in cardiac murmurs and have seldom been mentioned in cerebrovascular disease.
METHODS
A retrospective review of 12,000 patients from our neurosonographic data base of the past 7 years was conducted to find patients who had MMs during color-coded carotid and transcranial duplex sonographies.
RESULTS
Sixty-six musical murmurs were found in 60 patients (0.5% of all studied patients). There were 44 men and 16 women with a mean age of 63.8 years. Musical murmurs may occur with or without simultaneous turbulent flows, or very close to a high-intensity frequency (with systolic spindles) turbulent flow. Musical murmurs are detected more frequently in intracranial vessels (94%) than in extracranial cervical arteries. The pathologic changes corresponding to the area of MMs were high-grade stenosis of the arteries (58 MMs), small arteries serving as collateral circulation (5 MMs), carotid cavernous sinus fistulas (2 MMs), and Moyamoya disease (1 MM). Fifty (88%) of 57 patients with stenotic arterial lesions had histories of cerebral infarction or transient ischemic attack, and 64% of the cerebrovascular events occurred on the side appropriate to the MMs.
CONCLUSIONS
The presence of MMs in color-coded carotid duplex and transcranial color-coded duplex sonography imply severe underlying vascular diseases that require prompt treatment. Further cerebral angiographic study is warranted to clarify the underlying pathology in patients with MMs.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carotid Artery Diseases; Carotid Stenosis; Carotid-Cavernous Sinus Fistula; Cerebral Angiography; Cerebral Arterial Diseases; Cerebral Infarction; Cerebrovascular Circulation; Collateral Circulation; Female; Humans; Ischemic Attack, Transient; Male; Middle Aged; Moyamoya Disease; Regional Blood Flow; Retrospective Studies; Sound; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Transcranial
PubMed: 16908566
DOI: No ID Found -
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 -
BMC Medical Education Oct 2017Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary...
BACKGROUND
Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill.
METHODS
One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE).
RESULTS
Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE.
CONCLUSIONS
A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.
Topics: Adult; Clinical Competence; Curriculum; Diagnostic Techniques, Cardiovascular; Education, Medical, Graduate; Educational Measurement; Humans; Internal Medicine; Physical Examination; Point-of-Care Testing
PubMed: 28985729
DOI: 10.1186/s12909-017-1020-2 -
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