Cardiac Auscultation: Normal and Abnormal
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Innocent (Harmless) Heart Murmurs in Children
JAMA PATIENT PAGE The Journal of the American Medical Association PEDIATRIC HEART HEALTH Innocent (Harmless) Heart Murmurs in Children murmur is the sound of blood flowing through the heart and the large blood vessels that carry the blood through the body. Murmurs can be a A sign of a congenital (from birth) heart defect or can provide clues to illnesses that start elsewhere in the body and make the heart work harder, such as anemia or fever. In children, murmurs are often harmless and are just the sound of a heart working normally. These harmless murmurs are often called innocent or functional murmurs. Murmurs are easily heard in children because they have thin chests and the heart is closer to the stethoscope. When children have fevers or are scared, their hearts beat faster and murmurs can become even louder than usual. TYPES OF INNOCENT MURMURS • Still murmur is usually heard at the left side of the sternum (breastbone), in line with the nipple. This murmur is harder to hear when a child is sitting or lying on his or her stomach. • Pulmonic murmur is heard as blood flows into the pulmonary artery (artery of the lungs). It is best heard between the first 2 ribs on the left side of the sternum. • Venous hum is heard as blood flows into the jugular veins, the large veins in the neck. It is heard best above the clavicles (collarbones). Making a child look down or sideways can decrease the murmur. CHARACTERISTICS OF INNOCENT MURMURS • They are found in children aged 3 to 7 years. -
Heart Murmur, Incidental Finding
412 Heart Murmur, Incidental Finding (asymptomatic) mitral valve regurgitation. Technician Tips Count Respirations and Monitor Respiratory Relevant inclusion criteria for the trial that Teaching owners to keep a log of their pet’s Effort) demonstrated this effect were a vertebral resting respiratory rates can allow early detection heart sum > 10.5, an echocardiographic left of HF decompensation so that medications can SUGGESTED READING atrial–aortic ratio > 1.6, and left ventricular be adjusted and hopefully hospitalization for Atkins C, et al: ACVIM consensus statement. enlargement. acute HF can be avoided. Guidelines for the diagnosis and treatment of • ACE inhibition may have a positive effect on canine chronic valvular heart disease. J Vet Intern the time to development of stage C HF in Client Education Med 23:1142-1150, 2009. canine patients with left atrial enlargement Management of the veterinary patient with AUTHOR: Jonathan A. Abbott, DVM, DACVIM due to mitral valve regurgitation. chronic HF requires careful monitoring and EDITOR: Meg M. Sleeper, VMD, DACVIM • Evidence that medical therapy slows the relatively frequent adjustment of medical progression of HCM is lacking. therapy (see client education sheet: How to Client Education Heart Murmur, Incidental Finding Sheet Initial Database BASIC INFORMATION rate or body posture), short (midsystolic), single (unaccompanied by other abnormal • Thoracic radiographs may be considered Definition sounds), and small (not widely radiating). as the initial diagnostic test in small- to A heart murmur that is detected in the process medium-breed dogs with systolic murmurs of an examination that was not initially directed Etiology and Pathophysiology that are loudest over the mitral valve at the cardiovascular system • A heart murmur is caused by turbulent blood region. -
Viding Diagnostic Insights Into the Pathophysiologic Mechanisms
viding diagnostic insights into the pathophysiologic mechanisms under- lying the acoustic findings heard in clinical practice.162-165 Contemporary physicians should take advantage of the valuable clinical information that can be obtained by such an inexpensive instrument and expedient and reli- able tool as the stethoscope. The following section reviews the funda- mental technique of cardiac auscultation, emphasizing the diagnostic value and practical clinical applications of this time-honored (but endan- gered) art in this time of need.166 The Art and Technique of Cardiac Auscultation. Auscultation of the heart and vascular system is one of the most challenging and rewarding clinical diagnostic skills that can (and should) be learned and applied by every prac- ticing physician. Proficiency in cardiac auscultation requires experience, repeated practice, and a great deal of patience (and patients). Most impor- tantly, it requires a proper state of mind. (“we hear what we listen for”). Although the most vital component of the auscultatory apparatus lies between the earpieces, the proper use of a well-designed, efficient stetho- scope cannot be overemphasized. To ensure optimal sound transmission, the well-crafted stethoscope should be airtight, with snug but comfortably-fit- ting earpieces, properly aligned metal binaurals, and flexible, double-barrel, 1 thick-walled tubing, ⁄8 inch in internal diameter and no more than 12 to 15 inches in length. A high-quality stethoscope should be equipped with both bell and diaphragm chest pieces. The bell, when applied gently to the skin, will “bring out” low frequency sounds and murmurs (eg, faint S4 or S3 gal- lop or diastolic rumble) and the diaphragm, when pressed firmly against the skin, will accentuate high-pitched acoustic events (eg, diastolic blowing murmur of AR). -
A Case Report of Takotsubo Syndrome Complicated by Ischaemic Stroke: the Clinical Dilemma of Anticoagulation
European Heart Journal - Case Reports CASE REPORT doi:10.1093/ehjcr/ytab051 Other A case report of takotsubo syndrome complicated by ischaemic stroke: the clinical dilemma of anticoagulation Giuseppe Iuliano 1, Rosa Napoletano2, Carmine Vecchione 1,3, and Downloaded from https://academic.oup.com/ehjcr/article/5/3/ytab051/6170700 by guest on 01 October 2021 Rodolfo Citro 1* 1Cardiothoracic and Vascular Department, Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Heart Tower—Room 807, Largo Citta` d’Ippocrate, 84131 Salerno, Italy;; 2Neurology Department, Stroke Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Largo Citta` d’Ippocrate, 84131 Salerno, Italy; and 3Vascular Pathophysiology Unit, IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, Isernia, Italy Received 2 September 2020; first decision 22 October 2020; accepted 28 January 2021 For the podcast associated with this article, please visit https://academic.oup.com/ehjcr/pages/podcast Background Takotsubo syndrome (TTS) is an acute and transient heart failure syndrome due to reversible myocardial dysfunc- tion characterized by a wide spectrum of possible clinical scenarios. About one-fifth of TTS patients experience ad- verse in-hospital events. Thromboembolic complications, especially stroke, have been reported, albeit in a minority of patients. ................................................................................................................................................................................................... Case summary A 69-year-old woman presented to our emergency department for dyspnoea after a family quarrel. Electrocardiogram revealed ST-segment elevation in anterolateral leads and laboratory exams showed a slight ele- vation of high-sensitivity cardiac troponin. The patient was treated according to current guidelines on ST-elevation myocardial infarction and referred to the cath lab. Urgent coronary angiography revealed normal coronary arteries. -
Hemodynamic Monitoring and Circulatory Assist Devices
Hemodynamic Monitoring Hemodynamic Monitoring and Circulatory Assist Devices • Measurement of pressure, flow, and oxygenation within the cardiovascular system • Includes invasive and noninvasive measurements (Relates to Chapter 66, – Systemic and pulmonary arterial pressures “Nursing Management: Critical Care,” in the textbook) Hemodynamic Monitoring Hemodynamic Monitoring • Invasive and noninvasive measurements • Invasive and noninvasive measurements (cont’d) (cont’d) – Central venous pressure (CVP) – Stroke volume (SV)/stroke volume index (SVI) – Pulmonary artery wedge pressure (PAWP) – O2 saturation of arterial blood (SaO2) – Cardiac output (CO)/cardiac index (CI) – O2 saturation of mixed venous blood (SvO2) Hemodynamic Monitoring Hemodynamic Monitoring General Principles General Principles • Preload: Volume of blood within ventricle at • Contractility: Strength of ventricular end of diastole contraction • Afterload: Forces opposing ventricular • PAWP: Measurement of pulmonary capillary ejection pressure; reflects left ventricular end‐diastolic – Systemic arterial pressure pressure under normal conditions – Resistance offered by aortic valve – Mass and density of blood to be moved 1 Hemodynamic Monitoring Principles of Invasive Pressure General Principles Monitoring • CVP: Right ventricular preload or right • Equipment must be referenced and zero ventricular end‐diastolic pressure under balance to environment and dynamic normal conditions, measured in right atrium response characteristics optimized or in vena cava close to heart • -
Heart Murmur
Sacramento Heart & Vascular Medical Associates February 18, 2012 500 University Ave. Sacramento, CA 95825 Page 1 916-830-2000 Fax: 916-830-2001 Patient Information For: Only A Test Heart Murmur What is a heart murmur? A heart murmur is a sound that occurs between beats of the heart. The sound is made by blood flowing through the heart. It is similar to the sound water makes as it flows through a hose. A heart murmur does not necessarily mean that there is something wrong with the heart. How does it occur? Murmurs can result from: - the shape of the heart - abnormal heart structures, such as the valves or heart walls, which you may have had since birth - damaged or overworked heart valves resulting from medical problems such as rheumatic fever, heart attacks, infective endocarditis. When your heart beats faster, it changes the rate and amount of blood moving through your heart. This can cause heart murmurs. Some of the conditions that can cause your heart to beat faster are: - anemia - high blood pressure - pregnancy - fever - stress - thyroid problems. Most heart murmurs are heard in people with normal hearts. These innocent heart murmurs - also called functional, normal, vibratory, or physiologic murmurs - are harmless. They are common in children. Most murmurs go away for good as a child nears adulthood. What are the symptoms? Innocent heart murmurs do not cause any symptoms. If you have a heart problem that is causing the murmur, possible symptoms of a heart problem are: - shortness of breath - lightheadedness - decreased ability to exert yourself, for example, during activities such as climbing the stairs or even making a bed - frequent experiences of a rapid heart rate - chest pain. -
Heart Murmur
PATCHS PROGRAM PUBLIC HEALTH NURSE ADVOCATES TEACHING CHILD HEALTH AND SAFETY Riverside County Community Health Agency HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE (HCPCFC) COURT FLASH NEWSLETTER VOLUME 1 ISSUE 36 APRIL 2011 Medical Information Fact Sheet Heart Murmur What is a Heart Murmur? Heart murmurs are extra or unusual sounds heard during a heartbeat. Sometimes they sound like a whooshing or swishing noise. Doctors can hear these sounds and heart murmurs using a stethoscope. Causes The two types of heart murmurs are innocent (harmless) and abnormal. Innocent heart murmurs: Why some people have innocent heart murmurs and others do not is not known. These murmurs are common in healthy children and do not pose a health threat. Children do not need to take any medicine or be careful in any special way. Extra blood flow through the heart also may cause innocent heart murmurs. After childhood, the most common cause of extra blood flow through the heart is pregnancy. This is because during pregnancy, women's bodies make extra blood. Most heart murmurs that occur in pregnant women are innocent. Abnormal heart murmurs: People with abnormal heart murmurs may have signs or symptoms of heart problems. Most abnormal murmurs in children are caused by congenital heart defects. They change the normal flow of blood through the heart. Sometimes a heart murmur indicates a problem with the child's heart, such as, a hole in the heart, a leak in a heart valve or, a narrow heart valve. In adults, abnormal heart murmurs most often are caused by acquired heart valve disease. -
Time-Varying Elastance and Left Ventricular Aortic Coupling Keith R
Walley Critical Care (2016) 20:270 DOI 10.1186/s13054-016-1439-6 REVIEW Open Access Left ventricular function: time-varying elastance and left ventricular aortic coupling Keith R. Walley Abstract heart must have special characteristics that allow it to respond appropriately and deliver necessary blood flow Many aspects of left ventricular function are explained and oxygen, even though flow is regulated from outside by considering ventricular pressure–volume characteristics. the heart. Contractility is best measured by the slope, Emax, of the To understand these special cardiac characteristics we end-systolic pressure–volume relationship. Ventricular start with ventricular function curves and show how systole is usefully characterized by a time-varying these curves are generated by underlying ventricular elastance (ΔP/ΔV). An extended area, the pressure– pressure–volume characteristics. Understanding ventricu- volume area, subtended by the ventricular pressure– lar function from a pressure–volume perspective leads to volume loop (useful mechanical work) and the ESPVR consideration of concepts such as time-varying ventricular (energy expended without mechanical work), is linearly elastance and the connection between the work of the related to myocardial oxygen consumption per beat. heart during a cardiac cycle and myocardial oxygen con- For energetically efficient systolic ejection ventricular sumption. Connection of the heart to the arterial circula- elastance should be, and is, matched to aortic elastance. tion is then considered. Diastole and the connection of Without matching, the fraction of energy expended the heart to the venous circulation is considered in an ab- without mechanical work increases and energy is lost breviated form as these relationships, which define how during ejection across the aortic valve. -
2.3. Heart Sound and Auscultation
Dinesh Kumar Dinesh Dinesh Kumar CARDIOVASCULAR DISEASE ASSESSMENT DISEASE CARDIOVASCULAR AUTOMATIC HEART FOR SOUND AUTOMATIC ANALYSIS AUTOMATIC HEART SOUND ANALYSIS FOR CARDIOVASCULAR DISEASE ASSESSMENT Doctoral thesis submitted to the Doctoral Program in Information Science and Technology, supervised by Prof. Dr. Paulo Fernando Pereira de Carvalho and Prof. Dr. Manuel de Jesus Antunes, and presented to the Department of Informatics Engineering of the Faculty of Sciences and Technology of the University of Coimbra. September 2014 OIMBRA C E D NIVERSIDADE NIVERSIDADE U September 2014 Thesis submitted to the University of Coimbra in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Information Science and Technology This work was carried out under the supervision of Professor Paulo Fernando Pereira de Carvalho Professor Associado do Departamento de Engenharia Informática da Faculdade de Ciências e Tecnologia da Universidade de Coimbra and Professor Doutor Manuel J Antunes Professor Catedrático da Faculdade de Medicina da Universidade de Coimbra ABSTRACT Cardiovascular diseases (CVDs) are the most deadly diseases worldwide leaving behind diabetes and cancer. Being connected to ageing population above 65 years is prone to CVDs; hence a new trend of healthcare is emerging focusing on preventive health care in order to reduce the number of hospital visits and to enable home care. Auscultation has been open of the oldest and cheapest techniques to examine the heart. Furthermore, the recent advancement in digital technology stethoscopes is renewing the interest in auscultation as a diagnosis tool, namely for applications for the homecare context. A computer-based auscultation opens new possibilities in health management by enabling assessment of the mechanical status of the heart by using inexpensive and non-invasive methods. -
Left Ventricular Assist Device
Left Ventricular Assist Device PHI 2016 Objectives • Discuss conditions to qualify for LVAD Therapy • Discuss LVAD placement and other treatment modalities • Describe the Thoratec Heartmate 2 and Heartmate 3 systems • Discuss assessment changes of the LVAD patient • Review emergency care of the LVAD patient Stage C or D Heart Failure slide 3 LVAD Exclusion Criteria • Aortic Valve Competency – Sometimes valve is oversewn to allow adequate device function • RV Function- if RV dysfunction is present must be transplant candidate – No PPHTN unless candidate for heart-lung transplant • Hepatic Dysfunction- cirrhosis and portal HTN • Renal Dysfunction- Irreversible disease vs. disease due to poor perfusion – Long term dialysis and creatinine > 3.0 mg/dl • Cancer • Psych/Social Concerns slide 4 LVAD Referral • Symptoms • Hypotension – Recurrent admissions • Laboratory – Refractory • Renal insufficiency – At rest • Hepatic dysfunction • Medications • Hyponatremia – Intolerance or lower doses • Pulmonary Hypertension • ACE-I/ARBs • RV Dysfunction • Beta blockers • Unresponsiveness to CRT – Increasing diuretic doses (Cardiac Resynchronization Therapy) • Unable to carry out ADLs – Poor nutritional status • Inotropes slide 5 INTERMACS Classification slide 9 LVAD Implantation Process • Referral Phase – Referred to AHFC by primary cardiologist • Evaluation Phase (2-4 weeks) – Testing – Consults with each team member – Selection Committee meets weekly • Surgery Phase (~4-6 weeks) – Admit to CCU the day before surgery • Outpatient Phase – Weekly clinic -
Very Important Extra Information
Very important Extra information * Guyton corners, anythingthat is colored with grey is EXTRA explanation Heart sounds &Murmurs Objectives : • Enumerate the different heart sounds. • Describe the cause and characteristic features of first and second heart sounds. • Correlate the heart sounds with different phases of cardiac cycle. • Define murmurs and their clinical importance. 2 Contact us : [email protected] Areas of Auscultation • Guyton corner : ( Normal Heart Sounds ) : Listening with a stethoscope to a normal heart, onehears a sound usually described as “lub, dub, lub, dub.”The “lub”is associated with closure of the atrioventricular (A-V) valves at the beginning of systole, and the “dub”is associated with closure of the semilunar (aortic and pulmonary) valves at the end of systole. The “lub” sound is called the first heart sound, and the “dub”is called the second heart sound, because the normal pumping cycle of the heart is considered to start when the A-V valves close at the onset of ventricular systole. 3 Heart Sounds There are four heart sounds SI, S2, S3 & S4. Two heart sound are audible with stethoscope S1&S2 (Lub - Dub). S3 &S4 are not audible with stethoscope Under normal conditions because they are low frequency sounds. Ventricular Systole is between First and second Heart sound. Ventricular diastole is between Second and First heart sounds. 4 Heart Sounds • Guyton corner : Phonocardiogram If a microphone specially designed to detect low-frequency sound is placed on the chest, the heart sounds can be amplified and recorded by a high-speed recording apparatus. The recording is called a phonocardiogram, and the heart sounds appear as waves, as shown schematically . -
Heart Sound Classification for Murmur Abnormality Detection Using an Ensemble Approach Based on Traditional Classifiers and Feature Sets
Anatolian Journal of Computer Sciences Volume:5 No:1 2020 © Anatolian Science pp:1-13 ISSN:2548-1304 Heart Sound Classification for Murmur Abnormality Detection Using an Ensemble Approach Based on Traditional Classifiers and Feature Sets Ali Fatih Gündüz1*, Ali Karcı2 *1Akçadağ Voc. Highschool, Malatya Turgut Ozal Uni., Malatya, Turkey ([email protected]) 2Department of Computer Eng., Inonu University, Malatya, Turkey, ([email protected]) Received Date: Jan. 7, 2020. Acceptance Date: Mar. 21, 2020. Published Date : Jun. 1, 2020. Abstract— Phonocardiography (PCG) is a method based on examination of mechanical sounds coming from heart during its regular contraction/relaxation activities such as opening and closing of the valves and blood turbulence towards vessels and heart chambers. Today there are high technology tools to record those sounds in electronic environment and enable us to analyze them in detail. The constraints such as human’s limited audible range, environment noise and inexperience of physicians can be overcome by the use of those tools and development of state-of-art signal processing and machine learning methods. In this study we examined heart sounds and classified them as normal or abnormal focusing on the efficiency of ensemble classifiers. Features of heart sounds are extracted by using Discrete Wavelet Transform (DWT), Mel-Frequency Cepstral Coefficients (MFCC) and time-domain morphological characteristics of the signals. As a novel contribution, Karcı entropy is derived from DWT of PCG signals and used for the first time as feature in heart sound classification. K-Nearest Neighbor (kNN), Support Vector Machine (SVM), Multilayer Perceptron (MLP) classifiers and their ensembles are used as classifiers.