Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART I: PATIENTS AFTER ACUTE CORONARY SYNDROMES AND HEART FAILURE

Anesthetic Management of a Down Syndrome Patient for Ventricular Septal Defect Repair: A Case Report

It is commonly known that Down syndrome (DS) and congenital cardiovascular abnormalities go hand in hand. Most frequently, complete atrioventricular septal abnormalities have been linked to DS. Along with DS, ventricular septal defect (VSD), atrial septal defect, tetralogy of Fallot, and patent ductus arteriosus have also been reported. We present a case of DS with VSD who underwent VSD correction. Echocardiography prompted the diagnosis, which was then confirmed by surgery. The patient was successfully transferred out of the hospital. After correcting the VSD, the survival and quality of life of the DS patient have improved.

Development of a Multi-Channel Wearable Heart Sound Visualization System

A multi-channel wearable heart sound visualization system based on novel heart sound sensors for imaging cardiac acoustic maps was developed and designed. The cardiac acoustic map could be used to detect cardiac vibration and heart sound propagation. The visualization system acquired 72 heart sound signals and one ECG signal simultaneously using 72 heart sound sensors placed on the chest surface and one ECG analog front end. The novel heart sound sensors had the advantages of high signal quality, small size, and high sensitivity. Butterworth filtering and wavelet transform were used to reduce noise in the signals. The cardiac acoustic map was obtained based on the cubic spline interpolation of the heart sound signals. The results showed the heart sound signals on the chest surface could be detected and visualized by this system. The variations of heart sounds were clearly displayed. This study provided a way to select optimal position for auscultation of heart sounds. The visualization system could provide a technology for investigating the propagation of heart sound in the thoracic cavity.

Back to Basics: Key Physical Examinations and Theories in Patients with Heart Failure

Heart failure (HF) is a leading cause of hospitalization. Suitable pharmacologic management is critical. Distinct physical findings such as congestion and peripheral hypoperfusion need to be considered in selecting pharmacologic therapy. By applying the pretest probability and likelihood ratios of unique physical findings of HF to a Markov model, a definite posttest probability can be obtained. This article focuses on the findings of S3, jugular venous pressure, proportional pulse pressure, bendopnea, trepopnea, and various heart murmurs. Incorporating statistical precision in physical assessments, diagnoses of HF can be further refined, providing a sophisticated approach to evaluate patients hemodynamics status noninvasively.

Cardiac auscultation: Using physiologic maneuvers to further identify heart murmurs

Auscultation of heart sounds and murmurs often is taught in a simulated environment with optimal listening conditions. Clinicians' auscultation skills can wither if they do not have contact with patients with valvular heart disease during clinical practice, or if they rely on handheld ultrasound devices or echocardiography. This article reviews heart murmurs and how to use physiologic maneuvers during the cardiac examination to assist in identifying murmurs.