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van Staveren MDB, Muis E, Szatmári V. Self-Reported Management of Incidentally Detected Heart Murmurs in Puppies: A Survey among Veterinarians. Animals (Basel) 2024; 14:1821. [PMID: 38929440 PMCID: PMC11200448 DOI: 10.3390/ani14121821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/10/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Heart murmurs in puppies can be innocent or pathologic; the latter is almost always related to a congenital heart disease. Differentiating between these murmurs can be challenging for practicing veterinarians, but this differentiation is essential to ensure the best prognosis for puppies having a congenital heart disease. Our study aimed to reveal how veterinarians manage puppies with a heart murmur. METHODS A web-based questionnaire was sent to Dutch and Belgian veterinary practices. RESULTS Data from 452 respondents were analyzed. Though 88% of the respondents find detecting a heart murmur easy, only 9% find differentiating innocent murmurs from pathologic murmurs in puppies easy. Of the respondents, only 80% recommend immediate additional examination when detecting a loud heart murmur during the first veterinary health check at 6 weeks of age. Most of the respondents are aware that normal growth and the absence of clinical signs do not exclude severe congenital heart disease. Of the respondents, 31% were uncertain whether early surgical intervention could lead to improved outcomes. CONCLUSIONS Veterinarians are aware of the importance of echocardiography for puppies with a loud heart murmur, and recognize their limitations when differentiating an innocent from a pathological heart murmur in a puppy.
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Affiliation(s)
| | | | - Viktor Szatmári
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
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Li Y, Li Y, Zhang R, Li S, Liu Z, Zhang J, Fu Y. Progress in wearable acoustical sensors for diagnostic applications. Biosens Bioelectron 2023; 237:115509. [PMID: 37423066 DOI: 10.1016/j.bios.2023.115509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023]
Abstract
With extensive and widespread uses of miniaturized and intelligent wearable devices, continuously monitoring subtle spatial and temporal changes in human physiological states becomes crucial for daily healthcare and professional medical diagnosis. Wearable acoustical sensors and related monitoring systems can be comfortably applied onto human body with a distinctive function of non-invasive detection. This paper reviews recent advances in wearable acoustical sensors for medical applications. Structural designs and characteristics of the structural components of wearable electronics, including piezoelectric and capacitive micromachined ultrasonic transducer (i.e., pMUT and cMUT), surface acoustic wave sensors (SAW) and triboelectric nanogenerators (TENGs) are discussed, along with their fabrication techniques and manufacturing processes. Diagnostic applications of these wearable sensors for detection of biomarkers or bioreceptors and diagnostic imaging have further been discussed. Finally, main challenges and future research directions in these fields are highlighted.
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Affiliation(s)
- Yuyang Li
- Key Laboratory of Microsystems and Microstructures Manufacturing, Ministry of Education, Harbin Institute of Technology, Harbin, 150080, China
| | - Yuan Li
- Key Laboratory of Microsystems and Microstructures Manufacturing, Ministry of Education, Harbin Institute of Technology, Harbin, 150080, China
| | - Rui Zhang
- Functional Materials and Acousto-optic Instruments Institute, School of Instrumentation Science and Engineering, Harbin Institute of Technology, Harbin, 150080, China
| | - Songlin Li
- Key Laboratory of Microsystems and Microstructures Manufacturing, Ministry of Education, Harbin Institute of Technology, Harbin, 150080, China
| | - Zhao Liu
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, 150081, China.
| | - Jia Zhang
- Key Laboratory of Microsystems and Microstructures Manufacturing, Ministry of Education, Harbin Institute of Technology, Harbin, 150080, China.
| | - Yongqing Fu
- Faculty of Engineering and Environment, Northumbria University, Newcastle Upon Tyne, NE1 8ST, United Kingdom.
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Balogh M, Rishniw M, Vörös K. Remote Teaching of Canine Cardiac Auscultation Using Digital Phonocardiograms. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023; 50:104-110. [PMID: 35100100 DOI: 10.3138/jvme-2021-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Veterinary students often struggle to correctly interpret heart sounds. This study sought to evaluate if additional online training using digital phonocardiograms (DPCGs) improves students' ability to identify normal and pathologic heart sounds in dogs. Thirty-six randomly assigned veterinary students listened to and interpreted 10 audio recordings of normal heart sounds (2), heart murmurs (4), and arrhythmias (4) at the start and the end of a 4-week period. Twenty-two students participated in training with DPCGs, including those created from these recordings during this period, via a self-study website (n = 12) or online webinar (n = 10). Their results were compared with those of a control group (n = 14) that did not undergo additional training. Although pre- and post-training test scores did not differ between groups, both training groups showed within-group improvement between the two tests (p = .024, p = .037); the control group did not (p = .49). Although neither training group showed differences in ability to differentiate normal heart sounds from arrhythmias, both showed increased ability to detect and specify heart murmurs and provide refined diagnoses of detected arrhythmias. These results suggest additional training, even without actual patients, improves students' ability to identify heart murmurs and provide specific diagnoses for arrhythmias. Further study with a larger sample size and an additional group without DPCG-based training would help evaluate the effectiveness of DPCGs regarding arrhythmias. Studying a larger sample size would also allow for a training group participating in both training methods, measuring cumulative effectiveness of both methods.
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Affiliation(s)
- Márton Balogh
- Department and Clinic of Internal Medicine, University of Veterinary Medicine, Budapest, István u. 2, 1078 Budapest, Hungary
| | - Mark Rishniw
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853 USA
| | - Károly Vörös
- Department and Clinic of Internal Medicine, University of Veterinary Medicine, Budapest, István u. 2, 1078 Budapest, Hungary
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Balogh M, Rishniw M, Vörös K. A digitális fonokardiográfia szerepe a kutyák szívhangjainak hallgatózásos vizsgálatának oktatásában. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023; 50:e20210097. [PMID: 36857580 DOI: 10.3138/jvme-2021-0097.hu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Absztrakt Sok állatorvostanhallgatónak esik nehezére a szívhangok helyes értelmezése. Kutatásunk célja a digitális fonokardiogramokat felhasználó online, tanterven kívüli oktatás hatásának felmérése volt a hallgatók szívhangok felismerésével kapcsolatos diagnosztikai képességeire. Harminchat véletlenszerűen elosztott állatorvostanhallgató hallgatott meg és értelmezett 10 hangfelvételt élettani szívhangokról (2), szívzörejekről (4) és szívritmuszavarokról (4) egy négyhetes periódus elején és Végén. Huszonkét hallgató vett részt DPCG-ket felhasználó képzésben, egy önképző oldal (n = 12) és egy online webinar (n = 10) keretein belül. A két teszten elért eredményeiket egy kontrollcsoportéval vetettük össze (n = 14), akik nem vettek részt tanterven kívüli képzésben. Bár az elő- és utótesztek pontszámai nem különböztek szignifikánsan a csoportok között, mindkét oktatásban résztvevő csoport szignifikáns csoporton belüli javulást mutatott a két teszt között (p = 0,023, p = 0,037), míg a kontrollcsoport nem (p = 0,49). Bár egyik csoport sem ért el javulást az élettani szívhangok felismerésében és szívritmuszavaroktól való elkülönítésében, mindkét csoportban javulást láttunk a szívzörejek felismerésében és azonosításában, valamint az észlelt szívritmuszavarok azonosításában. Eredményeink alapján a hallgatók hallgatózásos vizsgálattal kapcsolatos diagnosztikai képességei javíthatóak tanterven kívüli oktatással, akár élő álatok igénybevétele nélkül is. További, nagyobb elemszámmal végzett, valamint DPCG-t nem használó oktatómódszereket alkalmazó kutatás szükséges a DPCG-k szerepének pontos meghatározásához. Egy emelt elemszámmal végzett kutatás lehetővé tenné továbbá egy kombinált oktatott csoport létrehozását, mérhetővé téve a két módszer kumulatív hatását. This translation was provided by the authors. To view the original article visit: https://doi.org/10.3138/jvme-2021-0097
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Affiliation(s)
- Márton Balogh
- Állatorvostudományi Egyetem, Belgyógyászati Tanszék és Klinika, Budapest, István u. 2, 1078 Budapest, Magyarország
| | - Mark Rishniw
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853 USA
| | - Károly Vörös
- Állatorvostudományi Egyetem, Belgyógyászati Tanszék és Klinika, Budapest, István u. 2, 1078 Budapest, Magyarország
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Hövener J, Pokar J, Merle R, Gehlen H. Association between Cardiac Auscultation and Echocardiographic Findings in Warmblood Horses. Animals (Basel) 2021; 11:3463. [PMID: 34944240 PMCID: PMC8698104 DOI: 10.3390/ani11123463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
Heart murmurs are detected frequently when auscultating horses and certain murmurs can usually be linked to specific valvular regurgitations. Limited information exists about the accuracy of these broad rules in warmblood horses and the influence of grade of the regurgitation and dimensional changes on murmur intensity. This study aims to clarify the accuracy of cardiac auscultation in warmblood horses and the influence of the grade of regurgitation and dimensional changes on the loudness of the murmur. In this retrospective study, 822 warmblood horses presented for cardiac examination in a large equine referral center in northern Germany underwent a thorough cardiac auscultation. In total, 653 of these revealed one or more heart murmurs. Most common auscultatory findings were left-sided systolic murmurs (68%) or left-sided diastolic murmurs (15%). On 635 of these horses, an echocardiographic examination was performed, revealing regurgitations of the mitral valve as the most common valvular regurgitation (77%) followed by regurgitations of the aortic valve (23%). Thirty-one percent of horses that underwent echocardiographic examination displayed dimensional changes of one or more compartments of the heart, with the left atrium being most affected (21%), followed by the left ventricle (13%). The main goal of this study was to link certain auscultatory findings with results of the echocardiographic examinations, trying to determine whether auscultation and echocardiography agreed on the valve affected, as well as to find out if loudness of the murmur coincided with grade of regurgitation and presence of dimensional changes. Agreement between auscultation and cardiac ultrasound was substantial (Kappa 0.74) if one or more murmurs and regurgitations were present and almost perfect (Kappa 0.94) if only one murmur and one regurgitation were found. Auscultation was particularly well suited for detection of left-sided systolic and diastolic murmurs, with 87% of left-sided systolic murmurs being caused by a mitral valve regurgitation and 81% of left-sided diastolic murmurs originating from an aortic valve regurgitation. We found a fair agreement between the grade of regurgitation and the respective murmur. Association was particularly good between mild regurgitations and low-grade murmurs, while differentiation between moderate to severe regurgitation based upon the loudness of the murmur was less reliable. Dimensional changes were usually linked to more severe regurgitations and higher-grade murmurs. However, a direct correlation between murmur intensity and the presence or severity of dimensional changes, independent of the grade of valvular regurgitation, could not be established in this cohort of horses.
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Affiliation(s)
- Jakob Hövener
- Equine Clinic Bargteheide, 22941 Bargteheide, Germany;
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universitaet Berlin, 14163 Berlin, Germany;
- Equine Clinic, Veterinary Department, Freie Universitaet Berlin, 14163 Berlin, Germany
| | - Julie Pokar
- Equine Clinic Bargteheide, 22941 Bargteheide, Germany;
| | - Roswitha Merle
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universitaet Berlin, 14163 Berlin, Germany;
| | - Heidrun Gehlen
- Equine Clinic, Veterinary Department, Freie Universitaet Berlin, 14163 Berlin, Germany
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Nath LC, Forbes G, Elliott AD, Tomren V, Ryan A, Franklin SH. Application of an electrocardiography device (iECG) for heart rhythm analysis after exercise in Thoroughbred horses. Aust Vet J 2021; 100:114-120. [PMID: 34859419 DOI: 10.1111/avj.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/08/2021] [Accepted: 11/14/2021] [Indexed: 12/01/2022]
Abstract
AliveCor is a smartphone electrocardiography device (iECG) providing automated heart rate (HR) and rhythm determination. Atrial fibrillation (AF) in horses often is paroxysmal and rapid ECG acquisition is needed for diagnostic confirmation. iECGs were collected post-race from 15 horses with AF and 64 horses in sinus rhythm (SR). Results of manual assessment were compared to 3 commercial algorithms for HR and rhythm. Agreement between manually derived HR (HRM ) and HR derived by the AliveECG Vet (HRVET ) and Kardia version-1 (KV1 HR) and Kardia advanced (KADV HR) algorithms was quantified by the Bland-Altman limits of agreement test. Agreement between manual rhythm classification and KV1 and KADV algorithms for AF and SR was calculated by the Kappa statistical coefficient. The agreement (bias, 95% limits), between HRM and HRVET was 7.1 BPM (-29 to 43) in AF and -4.2 BPM (-38 to 30) in SR, between HRM and KV1 HR, was -0.3 BPM (-31 to 30) in AF and 0.2 BPM (-3 to 4) in SR, and between HRM and KADV HR was 7.0 BPM (-29 to 43) in AF and 0.2 BPM (-3.9 to 4.2) in SR. Agreement between manual rhythm classification and KV1 was 0.36 (0.13-0.59), and KADV was 0.84 (0.68-0.99). Sensitivity and specificity for identification of AF and SR of the KV1 algorithm were 60, 100% and 83, 100%, respectively, and of KADV was 87, 100% and 93, 100% respectively. The Kardia algorithms improved precision for HR determination in SR but not AF. The advanced algorithm accurately distinguished between AF and SR. The iECG is suitable for recording episodes of AF following exercise.
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Affiliation(s)
- L C Nath
- University of Adelaide, Roseworthy, South Australia, Australia
| | - G Forbes
- Racing Victoria, Flemington, Victoria, Australia
| | - A D Elliott
- University of Adelaide, Adelaide, South Australia, Australia
| | - V Tomren
- Racing Victoria, Flemington, Victoria, Australia
| | - A Ryan
- University of Adelaide, Roseworthy, South Australia, Australia
| | - S H Franklin
- University of Adelaide, Roseworthy, South Australia, Australia
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Balogh M, Koch F, Siver L, Krima A, Vörös K. Digital phonocardiography of cardiac arrhythmias in dogs - Preliminary experiences. Acta Vet Hung 2021; 69:116-124. [PMID: 34270460 DOI: 10.1556/004.2021.00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022]
Abstract
Electronic stethoscopes and digital phonocardiograms (DPCGs) can be applied when diagnosing cardiac murmurs, but their use for cardiac arrhythmias is not described in veterinary medicine. Data of 10 dogs are presented in this preliminary study, demonstrating the applicability of these techniques. Although the number of artefacts and the amount of baseline noise produced by the two digitising systems used did not differ, the Welch Allyn Meditron system or similar ones capable of simultaneous recording of electrocardiograms (ECGs) and DPCGs provide a better option for clinical research and education, whilst the 3M Littmann 3200 system might be more suitable for everyday clinical settings. A combined system with simultaneous phonocardiogram and ECG, especially with wireless transmission, might be a solution in the future.
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Affiliation(s)
- Márton Balogh
- 1Department and Clinic of Internal Medicine, University of Veterinary Medicine Budapest, István u. 2, H-1078 Budapest, Hungary
| | | | | | | | - Károly Vörös
- 1Department and Clinic of Internal Medicine, University of Veterinary Medicine Budapest, István u. 2, H-1078 Budapest, Hungary
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Pedler C, Nath L, Agne GF, Hebart M, Franklin S. Heritability estimates of atrial fibrillation in Thoroughbred racehorses in Hong Kong and Australia. J Vet Cardiol 2021; 36:115-122. [PMID: 34218164 DOI: 10.1016/j.jvc.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common performance-limiting arrhythmia of racehorses. A genetic contribution has been suggested in Standardbred racehorses but has not been investigated in Thoroughbreds. The objective of this study was to determine the heritability of AF in Thoroughbred racehorses. ANIMALS, MATERIALS AND METHODS Horses racing between 2007 and 2019 in Hong Kong and Australia that had AF detected postrace via auscultation (n = 463 cases) were compared with five randomly selected racing contemporaries (n = 2,315 controls). The ASReml-R programme was used to fit an animal model to the AF data to estimate heritability using the entire data set and a subset of horses (n = 106 cases) that had electrocardiographic confirmation of AF. Variance components were estimated assuming AF was normally distributed and on the logit-transformed scale. The risk of producing AF-affected offspring was calculated using Fisher's exact test for stallions that sired ≥10 individuals in the case-control population. RESULTS Heritability on the underlying scale was 0.064 ± 0.04 (logit animal) and 0.071 ± 0.04 (normal animal) for the entire population and 0.065 ± 0.097 (logit animal) and 0.058 ± 0.11 (normal animal) for electrocardiographic-confirmed AF cases. Of 71 stallions that sired ≥10 individuals, three were more likely to produce affected offspring (odds ratio: 4.05-7.57; p < 0.01). Age (p = 0.991), sex (p = 0.830), and year of birth (p = 0.547) did not contribute to expression. CONCLUSIONS Although some stallions were overrepresented amongst affected horses, the heritability of AF in this population of Thoroughbreds was low. Environmental and individual factors contributing to AF development require further investigation.
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Affiliation(s)
- C Pedler
- School of Animal and Veterinary Science, University of Adelaide, Roseworthy Campus, Roseworthy, South Australia, 5353, Australia
| | - L Nath
- School of Animal and Veterinary Science, University of Adelaide, Roseworthy Campus, Roseworthy, South Australia, 5353, Australia
| | - G F Agne
- School of Animal and Veterinary Science, University of Adelaide, Roseworthy Campus, Roseworthy, South Australia, 5353, Australia
| | - M Hebart
- School of Animal and Veterinary Science, University of Adelaide, Roseworthy Campus, Roseworthy, South Australia, 5353, Australia
| | - S Franklin
- School of Animal and Veterinary Science, University of Adelaide, Roseworthy Campus, Roseworthy, South Australia, 5353, Australia.
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Mullowney D, Fuentes VL, Barfield D. Cardiac auscultation skills in final year veterinary students and recent veterinary graduates, referral hospital veterinary surgeons and veterinary cardiologists or cardiology residents. Vet Rec 2021; 189:e305. [PMID: 33870523 DOI: 10.1002/vetr.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cardiac auscultation is an important part of the physical examination. This study evaluated cardiac auscultation skills in veterinary students and compared their abilities to recent veterinary graduates, referral hospital veterinary surgeons and veterinary cardiologists or cardiology residents. In addition it compared their self-predicted quiz scores to their actual scores, evaluating if they could accurately predict their own performance level. METHODS A digital recording device was used to record auscultation sounds from 12 different patients with a diagnosis confirmed by a board-certified veterinary cardiologist. The sound files and associated phonocardiograms were uploaded to a video sharing website. A cloud-based online multiple-choice quiz was generated and shared with final year veterinary students, recent veterinary graduates, referral hospital veterinary surgeons and veterinary cardiologists or cardiology residents. RESULTS There were 128 participants: 51 final year veterinary students, 62 recent veterinary graduates, and 10 referral hospital veterinary surgeons and five veterinary cardiologists or cardiology residents. No difference was found between the cardiac auscultation skills of recent veterinary graduates and final year veterinary students. Veterinary students' self-predicted scores were lower than actual scores. CONCLUSIONS Recent veterinary graduates did not perform better than final year veterinary students in this study, suggesting that auscultation skills do not continue to improve in the first few years after graduation. Efforts should be made to maximise students' learning in cardiac auscultation skills. Veterinary students show a lack of confidence in cardiac auscultation skills.
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Affiliation(s)
- Deirdre Mullowney
- Department of Clinical Science and Services, Royal Veterinary College, Herts, UK
| | | | - Dominic Barfield
- Department of Clinical Science and Services, Royal Veterinary College, Herts, UK
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Nath LC, Elliott AD, Weir J, Curl P, Rosanowski SM, Franklin S. Incidence, recurrence, and outcome of postrace atrial fibrillation in Thoroughbred horses. J Vet Intern Med 2021; 35:1111-1120. [PMID: 33604980 PMCID: PMC7995445 DOI: 10.1111/jvim.16063] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) impacts performance and horse and jockey safety. Understanding the outcomes of AF identified postrace will better inform regulatory policy. HYPOTHESIS/OBJECTIVES To investigate the outcomes after episodes of AF identified postrace and determine whether affected horses are at increased risk of additional episodes compared to the general racing population. ANIMALS Total of 4684 Thoroughbred racehorses. METHODS Race records for Thoroughbred horses racing in Hong Kong from 2007 to 2017 were reviewed. Horses that performed below expectation were examined by cardiac auscultation and ECG. Incidence and recurrence of AF were compared between horses with and without a history of AF and between horses with paroxysmal and persistent episodes using Fisher's exact test. RESULTS There were 96 135 race starts during the study. Atrial fibrillation was identified in 4.9% of horses, with an overall incidence of 2.7 episodes per 1000 starts. The incidence of AF in horses after any previous episode (12.8 per 1000 starts) was higher than for horses with no previous episode (2.4 per 1000 starts; odds ratio [OR], 5.3; 95% confidence interval [CI], 3.8-7.6). Recurrence was seen in 64% of horses previously treated for persistent AF, which was higher than recurrence in horses with paroxysmal AF (23%; OR, 5.9; 95% CI, 1.6-21.2). Median duration between episodes was 343 days (range, 34-1065). CONCLUSIONS AND CLINICAL IMPORTANCE Thoroughbreds are at increased risk of recurrent AF after both paroxysmal and persistent episodes, but the duration of time between episodes varies widely. These findings support a substantial burden of AF among individual Thoroughbred racehorses.
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Affiliation(s)
- Laura C. Nath
- School of Animal & Veterinary SciencesUniversity of AdelaideRoseworthySouth AustraliaAustralia
| | - Adrian D. Elliott
- Centre for Heart Rhythm Disorders, Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Joe Weir
- Hong Kong Jockey Club, Veterinary Clinical ServicesEquine HospitalHong Kong SARHong Kong
| | - Peter Curl
- Veterinary RegulationHong Kong Jockey ClubHong Kong SARHong Kong
| | | | - Samantha Franklin
- School of Animal & Veterinary SciencesUniversity of AdelaideRoseworthySouth AustraliaAustralia
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van Staveren MDB, Szatmári V. Detecting and recording cardiac murmurs in clinically healthy puppies in first opinion veterinary practice at the first health check. Acta Vet Scand 2020; 62:37. [PMID: 32586343 PMCID: PMC7315505 DOI: 10.1186/s13028-020-00535-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background The frequency that cardiac murmurs are identified and recorded in first opinion veterinary practices at the first health check in puppies is unknown. The aims of the study were to assess the agreement between first opinion veterinary practitioners, a veterinary student and a veterinary cardiology specialist on detecting murmurs, and to establish whether abnormal auscultation findings had been recorded in the health certificates of clinically healthy puppies. The study included prospective and retrospective investigations, where the prospectively collected auscultation findings from a veterinary cardiology specialist and a trained veterinary student were compared to auscultation findings recorded by first opinion veterinary practitioners. Results Cardiac auscultation was performed on 331 client-owned, clinically healthy dogs at two time points: at age 34–69 days by a first opinion veterinary practitioner and at age 45–76 days, on average 9 days later, by a veterinary cardiology specialist and a trained veterinary student. Agreement among the three was compared for the presence of a murmur. The degree of inter-observer agreement was evaluated using Cohen’s kappa. Auscultation findings, as noted in the pets’ passports, from 331 puppies and 43 different first opinion veterinary practices, were retrospectively reviewed and prospectively compared with auscultation findings from a veterinary cardiology specialist. Agreement between the veterinary cardiology specialist and the first opinion veterinary practitioners was poor (ϰ = 0.01) and significantly different (P < 0.001). First opinion veterinary practitioners had recorded a cardiac murmur in only 1 of the 97 puppies in which the veterinary cardiology specialist detected a murmur. Two-hundred-and-fifty-two puppies were auscultated by both the veterinary cardiology specialist and the student. Their agreement was fair (ϰ = 0.40) and significantly different (P = 0.024). The agreement between the student and a first opinion veterinary practitioner on these 252 puppies was poor (ϰ = 0.03) and significantly different (P < 0.001). Conclusions This study shows that soft cardiac murmurs are rarely documented during the first veterinary health check in puppies by first opinion veterinary practitioners. Although soft murmurs may not be clinically relevant, finding and recording them is evidence of a carefully performed auscultation. Missing a non-pathological murmur is not of clinical importance; however, missing a pathological murmur could prove detrimental for the individual puppy.
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12
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Zuber N, Zuber M, Schwarzwald CC. Assessment of systolic and diastolic function in clinically healthy horses using ambulatory acoustic cardiography. Equine Vet J 2018; 51:391-400. [DOI: 10.1111/evj.13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Affiliation(s)
- N. Zuber
- Clinic for Equine Internal Medicine, Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - M. Zuber
- Division of Cardiology University of Zurich Zurich Switzerland
| | - C. C. Schwarzwald
- Clinic for Equine Internal Medicine, Vetsuisse Faculty University of Zurich Zurich Switzerland
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Marinus SM, van Engelen H, Szatmári V. N-Terminal Pro-B-Type Natriuretic Peptide and Phonocardiography in Differentiating Innocent Cardiac Murmurs from Congenital Cardiac Anomalies in Asymptomatic Puppies. J Vet Intern Med 2017; 31:661-667. [PMID: 28316101 PMCID: PMC5435073 DOI: 10.1111/jvim.14667] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/21/2016] [Accepted: 01/05/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Differentiating innocent cardiac murmurs from murmurs caused by congenital cardiac anomalies can be challenging with auscultation alone in asymptomatic puppies. HYPOTHESIS Plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations and phonocardiograms recorded by an electronic stethoscope can differentiate innocent from pathologic cardiac murmurs. ANIMALS A total of 186 client-owned asymptomatic dogs: 135 Cairn Terriers (age: 45-124 days), 20 adult Cairn Terriers (age: 7.5 months to 13.5 years), and 31 puppies of various breeds (age: 29-396 days). METHODS Study design is a cross-sectional survey. Each dog was auscultated, and when a cardiac murmur was heard, a phonocardiogram was recorded and an echocardiogram was performed. Plasma NT-proBNP concentrations were measured by a single laboratory by an ELISA. RESULTS No significant (P = .41) difference in plasma NT-proBNP levels was found between puppies without a murmur and puppies with an innocent murmur (median 300 versus 326 pmol/L), and between clinically healthy adult Cairn Terriers and Cairn Terrier puppies. Plasma NT-proBNP levels in puppies with a congenital heart disease were significantly (P < .001) higher than those in puppies with innocent murmurs (median 1,102 versus 326 pmol/L). However, some puppies with severe pulmonic stenosis did not have increased plasma NT-proBNP levels. On phonocardiograms, innocent murmurs had a significantly (P < .001) shorter "murmur-to-systole duration ratio" than the abnormal ones (median 66 versus 100%). The "murmur-to-S1 (first cardiac sound) amplitude ratio" was significantly (P < .001) lower of the innocent murmurs compared with that of the abnormal ones (median 16 versus 58 %). CONCLUSIONS AND CLINICAL IMPORTANCE Plasma NT-proBNP concentrations within the reference range do not rule out a congenital cardiac anomaly. Murmurs longer than 80% of the systole are most likely abnormal, whereas murmurs shorter than that could be either innocent or pathologic.
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Affiliation(s)
- S M Marinus
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - H van Engelen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - V Szatmári
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Szatmári V, van Leeuwen MW, Teske E. Innocent Cardiac Murmur in Puppies: Prevalence, Correlation with Hematocrit, and Auscultation Characteristics. J Vet Intern Med 2015; 29:1524-8. [PMID: 26415555 PMCID: PMC4895663 DOI: 10.1111/jvim.13632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 08/14/2015] [Accepted: 09/01/2015] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- V Szatmári
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - M W van Leeuwen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - E Teske
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Stevens KB, Marr CM, Horn JNR, Pfeiffer DU, Perkins JD, Bowen IM, Allan EJ, Campbell J, Elliott J. Effect of left-sided valvular regurgitation on mortality and causes of death among a population of middle-aged and older horses. Vet Rec 2009; 164:6-10. [DOI: 10.1136/vr.164.1.6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- K. B. Stevens
- Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA
| | - C. M. Marr
- Rossdales Equine Hospital; Cotton End Road, Exning Newmarket Suffolk CB8 7NN
| | | | - D. U. Pfeiffer
- Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA
| | - J. D. Perkins
- Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA
| | - I. M. Bowen
- School of Veterinary Medicine; University of Nottingham; Sutton Bonington Campus, Sutton Bonington Leicestershire LE12 5RD
| | - E. J. Allan
- Davison Veterinary Surgeons; 65 Ilkeston Road Nottingham NG7 3GR
| | - J. Campbell
- Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA
| | - J. Elliott
- Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA
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Abutarbush SM, Naylor JM, Parchoma G, D'Eon M, Petrie L, Carruthers T. Evaluation of traditional instruction versus a self-learning computer module in teaching veterinary students how to pass a nasogastric tube in the horse. JOURNAL OF VETERINARY MEDICAL EDUCATION 2006; 33:447-54. [PMID: 17035223 DOI: 10.3138/jvme.33.3.447] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a self-learning computer module (SLCM) versus traditional instruction in teaching how to pass a nasogastric tube (NG) in the horse. DESIGN A double-blind, monocentric study. SAMPLE POPULATION 52 third-year students in the DVM program were randomly assigned to two groups: traditional instruction (N = 25) or SLCM instruction (N = 27). PROCEDURE Traditional instruction consisted of an instructor and live demonstration; SCLM students were given a CD-ROM each. Both sessions lasted one hour. The students were then united in one session to practice passing the NG tube. Their performance was videotaped and evaluated by two evaluators. Students were then given a multiple-choice knowledge quiz. One week later, a second demonstration of the same procedure by the two methods was administered, and students were allowed to choose either method of instruction. A Likert-scale questionnaire about their comfort, their confidence, and the appropriateness of the teaching method was given after the second demonstration. Data were analyzed by non-parametric tests. A focus-group study was conducted to determine students' perception of each teaching method. Nine participants in the experiment volunteered for these focus-group sessions. The sessions were audiotaped and transcribed. RESULTS Students in the SLCM group performed significantly better on the test of knowledge than traditionally instructed students. The questionnaire found significant perceived benefits to computer-based instruction, including a preference for the computer-based module, better learning, and greater preparedness. In hands-on skill, time to pass the NG tube on the successful attempt was significantly shorter in the SLCM group than in the traditionally instructed group. The data from focus-group sessions suggest that while participants expressed satisfaction with both modes of instruction, the SLCM group reported somewhat higher levels of confidence in their skills prior to performing the procedure. Whereas the traditional group reported a strong preference for continued live demonstrations of the procedure, the SLCM group stated that the computer-assisted module alone provided them with effective instruction. CONCLUSION Computer-assisted learning is an acceptable and effective method of training students to pass an NG tube with potential welfare, proficiency, and knowledge advantages.
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Affiliation(s)
- Sameeh M Abutarbush
- Department of Large Animal Sciences, WCVM, University of Saskatchewan, Saskatoon, SK, Canada.
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Chetboul V, Athanassiadis N, Concordet D, Nicolle A, Tessier D, Castagnet M, Pouchelon JL, Lefebvre HP. Observer-dependent variability of quantitative clinical endpoints: the example of canine echocardiography. J Vet Pharmacol Ther 2004; 27:49-56. [PMID: 14995967 DOI: 10.1046/j.0140-7783.2003.00543.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The objective of this study was to determine the intra- and inter-observer variability of echocardiographic measurements in dogs. Four observers with different levels of experience in echocardiography performed 192 echocardiographic examinations of six dogs on four different days. The lowest within- and between-day coefficients of variation (CV) (%) were 13.8 and 5.2 for the right ventricle in diastole, 8.9 and 4.5 for the interventricular septal thickness in diastole (6.3 and 7.0 in systole), 7.7 and 9.4 for the left ventricular free-wall thickness in diastole (8.1 and 5.2 in systole), 3.1 and 5.0 for the left ventricular end-diastolic diameter (6.2 and 7.0 for end-systolic diameter), 10.2 and 10.8 for the left ventricular shortening fraction, and 8.2 and 9.8 for the left atrium/aorta ratio, respectively. Most of these lowest CVs were observed by the two most experienced observers. Conversely, all maximum values were obtained with the two less experienced observers. These differences in observer-dependent variability may considerably influence the minimum number of animals required to detect a treatment-associated change in echocardiographic variables.
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Affiliation(s)
- V Chetboul
- Unité de Cardiologie, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort cedex, France
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Naylor JM, Wolker RE, Pharr JW. An assessment of the terminology used by diplomates and students to describe the character of equine mitral and aortic valve regurgitant murmurs: correlations with the physical properties of the sounds. J Vet Intern Med 2003; 17:332-6. [PMID: 12774975 DOI: 10.1111/j.1939-1676.2003.tb02457.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Twenty students and 16 diplomates listened to 7 recordings made from 7 horses with either aortic (n = 3) or mitral valve (n = 4) regurgitant murmurs. A total of 30 different terms were used to describe the character of these murmurs. However, only 4 terms were used in a repeatable and consistent manner. Most people described the character of a given mitral or aortic valve murmur with 1 or 2 terms. Diplomates drew from a pool of terms that was about half the size of that used by students--8.1 +/- 2.0 terms for diplomats (mean +/- 1 SD) versus 13.1 +/- 1.8 terms for students (P > .001). Only blowing, honking, buzzing, and musical were markedly associated with the recording played. Frequency analysis of the murmurs allowed them to be classified as containing harmonics (n = 4) or not containing harmonics (n = 3). Blowing was used to describe murmurs without harmonics on 39 of 48 occasions and corresponds to the term noisy used in some older descriptions of equine murmurs. Honking, musical, and buzzing were markedly associated with murmurs that contained harmonics; these terms were used 23, 13, and 12 of a possible 64 times, respectively. The frequency of buzzing and honking murmurs (72.7 +/- 9.3 and 88.4 +/- 46.3 Hz, respectively) was markedly lower than that of musical murmurs (156.8 +/- 81.1 Hz) (all P values < .01). Honking murmurs (0.392 +/- 0.092 seconds) were shorter than those described as buzzing or musical (0.496 +/- 0.205 and 0.504 +/- 0.116 seconds, respectively). The data suggest that the terminology for the character of aortic and mitral regurgitant murmurs should be restricted to 4 terms: blowing, honking, buzzing, and musical. Honking, buzzing, and musical describe murmurs with a peak dominant frequency and harmonics; blowing describes murmurs without a peak frequency. Effective communication could be enhanced by playing examples of reference sounds when these terms are taught so that nomenclature is used more uniformly.
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Affiliation(s)
- Jonathan M Naylor
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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