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Iuliani K, Lawler A, Schrope D, Locke E. Echocardiographic and pathologic identification of an aorto-left atrial fistula secondary to infective endocarditis in a canine patient. J Vet Cardiol 2024; 52:61-67. [PMID: 38430823 DOI: 10.1016/j.jvc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 03/05/2024]
Abstract
A dog was presented for lameness, fever, and extreme lethargy. On physical exam, a new heart murmur, arrhythmia, and joint effusion were detected. These findings were not detected two months prior. A diagnostic work-up confirmed septic suppurative inflammation in multiple joints. Echocardiogram revealed aortic valvular endocarditis along with a communication, as a consequence of a fistula, that extended from just below the aortic sinotubular junction to the left atrial lumen. Due to a poor prognosis, humane euthanasia was elected. Necropsy and histopathology confirmed infective endocarditis of the aortic valve and an aorto-left atrial fistulous tract extending from the left coronary sinus of the aortic valve to the lumen of left atrium.
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Affiliation(s)
- K Iuliani
- Oradell Animal Hospital, 580 Winters Ave, Paramus, NJ, 07652, USA.
| | - A Lawler
- Oradell Animal Hospital, 580 Winters Ave, Paramus, NJ, 07652, USA
| | - D Schrope
- Oradell Animal Hospital, 580 Winters Ave, Paramus, NJ, 07652, USA
| | - E Locke
- Antech Diagnostics, 7555 Danbro Crescent, Mississauga, ON, L5N 6P9, Canada
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Inoue N, Morikawa S. Giant left ventricular lipoma. J Echocardiogr 2023; 21:177-178. [PMID: 35980555 DOI: 10.1007/s12574-022-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/19/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Naoya Inoue
- Department of Cardiology, Chutoen General Medical Center, Syoubugauraike 1-1, Kakegawa City, Shizuoka Prefecture, 436-8555, Japan.
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Shuji Morikawa
- Department of Cardiology, Chutoen General Medical Center, Syoubugauraike 1-1, Kakegawa City, Shizuoka Prefecture, 436-8555, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Aherne M. Cardiac Disease and Screening in Breeding Dogs. Vet Clin North Am Small Anim Pract 2023:S0195-5616(23)00074-8. [PMID: 37353418 DOI: 10.1016/j.cvsm.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Acquired and congenital heart diseases are relatively common in dogs, particularly in certain breeds. Modes of inheritance and genetic causes have been established for several cardiac diseases within various breeds. Breed screening is used to try and reduce the prevalence of certain canine cardiac diseases. Although breed screening seems to help reduce the prevalence of canine heart disease, the outcomes of specific breeding programs are variable and depend on multiple factors.
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Affiliation(s)
- Michael Aherne
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, 2015 Southwest 16th Avenue, Gainesville, FL 32610, USA.
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Fan M, Wang Q, Liu J, Su L, Wang B, Xu H, Li Q, Zhang Z. Real-world evaluation of the Stemoscope electronic tele-auscultation system. Biomed Eng Online 2022; 21:63. [PMID: 36068509 DOI: 10.1186/s12938-022-01032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the spread of COVID-19, telemedicine has played an important role, but tele-auscultation is still unavailable in most countries. This study introduces and tests a tele-auscultation system (Stemoscope) and compares the concordance of the Stemoscope with the traditional stethoscope in the evaluation of heart murmurs. METHODS A total of 57 patients with murmurs were recruited, and echocardiographs were performed. Three cardiologists were asked to correctly categorize heart sounds (both systolic murmur and diastolic murmur) as normal vs. abnormal with both the Stemoscope and a traditional acoustic stethoscope under different conditions. Firstly, we compared the in-person auscultation agreement between Stemoscope and the conventional acoustic stethoscope. Secondly, we compared tele-auscultation (recorded heart sounds) agreement between Stemoscope and acoustic results. Thirdly, we compared both the Stemoscope tele-auscultation results and traditional acoustic stethoscope in-person auscultation results with echocardiography. Finally, ten other cardiologists were asked to complete a qualitative questionnaire to assess their experience using the Stemoscope. RESULTS For murmurs detection, the in-person auscultation agreement between Stemoscope and the acoustic stethoscope was 91% (p = 0.67). The agreement between Stemoscope tele-auscultation and the acoustic stethoscope in-person auscultation was 90% (p = 0.32). When using the echocardiographic findings as the reference, the agreement between Stemoscope (tele-auscultation) and the acoustic stethoscope (in-person auscultation) was 89% vs. 86% (p = 1.00). The system evaluated by ten cardiologists is considered easy to use, and most of them would consider using it in a telemedical setting. CONCLUSION In-person auscultation and tele-auscultation by the Stemoscope are in good agreement with manual acoustic auscultation. The Stemoscope is a helpful heart murmur screening tool at a distance and can be used in telemedicine.
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Lv J, Dong B, Lei H, Shi G, Wang H, Zhu F, Wen C, Zhang Q, Fu L, Gu X, Yuan J, Guan Y, Xia Y, Zhao L, Chen H. Artificial intelligence-assisted auscultation in detecting congenital heart disease. Eur Heart J Digit Health 2021; 2:119-124. [PMID: 36711176 PMCID: PMC9708038 DOI: 10.1093/ehjdh/ztaa017] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/01/2020] [Accepted: 12/18/2020] [Indexed: 02/01/2023]
Abstract
Aims Computer-assisted auscultation has become available to assist clinicians with physical examinations to detect congenital heart disease (CHD). However, its accuracy and effectiveness remain to be evaluated. This study seeks to evaluate the accuracy of auscultations of abnormal heart sounds of an artificial intelligence-assisted auscultation (AI-AA) platform we create. Methods and results Initially, 1397 patients with CHD were enrolled in the study. The samples of their heart sounds were recorded and uploaded to the platform using a digital stethoscope. By the platform, both remote auscultation by a team of experienced cardiologists from Shanghai Children's Medical Center and automatic auscultation of the heart sound samples were conducted. Samples of 35 patients were deemed unsuitable for the analysis; therefore, the remaining samples from 1362 patients (mean age-2.4 ± 3.1 years and 46% female) were analysed. Sensitivity, specificity, and accuracy were calculated for remote auscultation compared to experts' face-to-face auscultation and for artificial intelligence automatic auscultation compared to experts' face-to-face auscultation. Kappa coefficients were measured. Compared to face-to-face auscultation, remote auscultation detected abnormal heart sound with 98% sensitivity, 91% specificity, 97% accuracy, and kappa coefficient 0.87. AI-AA demonstrated 97% sensitivity, 89% specificity, 96% accuracy, and kappa coefficient 0.84. Conclusions The remote auscultations and automatic auscultations, using the AI-AA platform, reported high auscultation accuracy in detecting abnormal heart sound and showed excellent concordance to experts' face-to-face auscultation. Hence, the platform may provide a feasible way to screen and detect CHD.
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Affiliation(s)
- Jingjing Lv
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China,Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Bin Dong
- Pediatric AI Clinical Application and Research Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Hao Lei
- Shanghai FitGreat Network Technology Co. Ltd, Room 402, Building 32, No. 680 Guiping Road, Xuhui District, Shanghai 200233, PR China
| | - Guocheng Shi
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Hansong Wang
- Pediatric AI Clinical Application and Research Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China,Child Health Advocacy Institute, China Hospital Development Institute of Shanghai Jiaotong University, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Fang Zhu
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Chen Wen
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Qian Zhang
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Lijun Fu
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Xiaorong Gu
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Jiajun Yuan
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Yongmei Guan
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Yuxian Xia
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China
| | - Liebin Zhao
- Pediatric AI Clinical Application and Research Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China,Child Health Advocacy Institute, China Hospital Development Institute of Shanghai Jiaotong University, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China,Corresponding authors. Tel: +86 18930830797, (H.C.); Tel: +86 18930830660, (L.Z.)
| | - Huiwen Chen
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China,Pediatric AI Clinical Application and Research Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, NO.1678 Dongfang Road, Pudong New District, Shanghai 200127, PR China,Corresponding authors. Tel: +86 18930830797, (H.C.); Tel: +86 18930830660, (L.Z.)
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Abstract
Chest pain and heart murmurs are common issues primary care providers must evaluate and manage. Both are a source of anxiety for patients, parents, and providers, necessitating evaluation and understanding to ensure appropriate management. Most pediatric chest pain can be treated symptomatically and with reassurance. This article examines the approach to pediatric chest pain including identification of key historical points, common causes of chest pain, and when to refer. The article also delineates our approach to auscultation, describes common benign murmurs, and offers suggestions on when to refer for further evaluation.
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Affiliation(s)
- Christopher A Sumski
- Herma Heart Institute, Children's Wisconsin & Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | - Benjamin H Goot
- Herma Heart Institute, Children's Wisconsin & Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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Ward J, Mochel JP, Seo YJ, Sathe S. Effects of the estrous cycle and pregnancy status on cardiovascular variables in healthy bitches. J Vet Cardiol 2020; 30:57-68. [PMID: 32688281 DOI: 10.1016/j.jvc.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The aim of the study was to characterize changes in maternal cardiovascular variables throughout the reproductive cycle in healthy bitches and determine whether magnitude of pregnancy-induced changes correlates to litter size. ANIMALS Eleven client-owned breeding bitches were included in the study. MATERIALS AND METHODS Bitches were enrolled prospectively and followed up longitudinally throughout a single reproductive cycle. Physical examination, echocardiography, blood pressure analysis, and plasma volume estimation were performed during proestrus, diestrus (early and late pregnancy), and anestrus. Fetal echocardiography was performed during late pregnancy. Data were compared across visits using a linear mixed-effects model, and correlation between variables was assessed. RESULTS Compared with proestrus, no significant changes were observed at any phase of the cycle in heart rate, blood pressure, echocardiographic measurements of left ventricular size or function, or echocardiographic calculations of stroke volume or cardiac output. Estimated plasma volume increased by 29.6% in early pregnancy (p < 0.001) and 70.7% in late pregnancy (p < 0.001). Fetal echocardiography was feasible in a subset of fetuses for each bitch. There was a significant correlation between estimated total fetal cardiac output and late pregnancy increase in maternal cardiac output (p = 0.0025). The incidence of physiologic heart murmurs ranged from 5 of 11 (45%) bitches in proestrus to 2 of 11 (18%) bitches in late pregnancy, attributed to variations in aortic outflow velocity. CONCLUSIONS Hemodynamic alterations in pregnant bitches do not result in consistently detectable echocardiographic changes, suggesting that cardiac screening could be diagnostic at any time during a reproductive cycle. Physiologic heart murmurs were common in this study population and not obviously associated with the reproductive cycle.
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Arslan D, Sami Tutar M, Kozanhan B, Bagci Z. The quality, understandability, readability, and popularity of online educational materials for heart murmur. Cardiol Young 2020; 30:328-36. [PMID: 31875800 DOI: 10.1017/S104795111900307X] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Murmurs are abnormal audible heart sounds produced by turbulent blood flow. Therefore, murmurs in a child may be a source of anxiety for family members. Families often use online materials to explore possible reasons for these murmurs, given the accessibility of information on the Internet. In this study, we evaluated the quality, understandability, readability, and popularity of online materials about heart murmur. METHODS An Internet search was performed for "heart murmur" using the Google search engine. The global quality score (on a scale of 1 to 5, corresponding to poor to excellent quality) and Health on the Net code were used to measure the quality of information presented. The understandability of the web pages identified was measured using the Patient Education Materials Assessment Tool (score range from 0 to 100%, scores below 70% reflect poor performance). The readability of each web pages was assessed using four validated indices: the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, the Gunning Frequency of Gobbledygook, and the Simple Measure of Gobbledygook. The ALEXA traffic tool was used to reference domains' popularity and visibility. RESULTS We identified 230 English-language patient educational materials that discussed heart murmur. After exclusion, a total of 86 web pages were evaluated for this study. The average global quality score was 4.34 (SD = 0.71; range from 3 to 5) indicating that the quality of information of most websites was good. Only 14 (16.3%) websites had Health on the Net certification. The mean understandability score for all Internet-based patient educational materials was 74.6% (SD = 12.8%; range from 31.2 to 93.7%). A score suggesting these Internet-based patient educational materials were "easy to understand". The mean readability levels of all patient educational materials were higher than the recommended sixth-grade reading level, according to all indices applied. This means that the level of readability is difficult. The average grade level for all web pages was 10.4 ± 1.65 (range from 7.53 to 14.13). The Flesch-Kincaid Grade level was 10 ± 1.81, the Gunning Frequency of Gobbledygook level was 12.1 ± 1.85, and the Simple Measure of Gobbledygook level was 9.1 ± 1.38. The average Flesch Reading Ease Score was 55 ± 9.1 (range from 32.4 to 72.9). CONCLUSION We demonstrated that web pages describing heart murmurs were understandable and high quality. However, the readability level of the websites was above the recommended sixth-grade reading level. Readability of written materials from online sources need to be improved. However, care must be taken to ensure that the information of web pages is of a high quality and understandable.
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Theis NJ, Calvert T, McIntyre P, Robertson SP, Wheeler BJ. Cantu syndrome and hypopituitarism: implications for endocrine monitoring. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190103. [PMID: 31743099 PMCID: PMC6865860 DOI: 10.1530/edm-19-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY Cantu syndrome, or hypertrichotic osteochondrodysplasia, is a rare, autosomal dominant genetically heterogeneous disorder. It is characterized by hypertrichosis, cardiac and skeletal anomalies and distinctive coarse facial features. We report a case where slowed growth velocity at 13 years led to identification of multiple pituitary hormone deficiencies. This adds to other reports of pituitary abnormalities in this condition and supports inclusion of endocrine monitoring in the clinical surveillance of patients with Cantu syndrome. LEARNING POINTS Cantu syndrome is a rare genetic disorder caused by pathogenic variants in the ABCC9 and KCNJ8 genes, which result in gain of function of the SUR2 or Kir6.1 subunits of widely expressed KATP channels. The main manifestations of the syndrome are varied, but most commonly include hypertrichosis, macrosomia, macrocephaly, coarse 'acromegaloid' facies, and a range of cardiac defects. Anterior pituitary dysfunction may be implicated in this disorder, and we propose that routine screening should be included in the clinical and biochemical surveillance of patients with Cantu syndrome.
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Affiliation(s)
- Nicholas J Theis
- Dunedin School of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Toby Calvert
- Dunedin School of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter McIntyre
- Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Stephen P Robertson
- Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Benjamin J Wheeler
- Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Abstract
The pediatric cardiology field has developed rapidly over the past few decades. More children than ever born with congenital heart disease (CHD) are growing into adulthood. Primary care providers play a key role in diagnosis, management, and referral of children with CHD because many common cardiac complaints (eg, feeding intolerance, cyanosis, chest pain, palpitations, and syncope) are first addressed in the primary care setting. The spectrum of heart disease in children ranges from common complaints to complex single-ventricle physiology, acute myocarditis, and heart transplantation. This article reviews the pathophysiology and management of the most frequent cardiac conditions encountered in primary care.
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Affiliation(s)
- Richard U Garcia
- Division of Cardiac Critical Care Medicine, Departments of Pediatrics and Critical Care Medicine, The University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street, Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Stacie B Peddy
- Division of Cardiac Critical Care Medicine, Departments of Pediatrics and Critical Care Medicine, The University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street, Civic Center Boulevard, Philadelphia, PA 19104, USA
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Rodríguez-González M, Alonso-Ojembarrena A, Castellano-Martínez A, Estepa-Pedregosa L, Benavente-Fernández I, Lubián López SP. [ Heart murmur in children less than 2 years-old: looking for a safe and effective referral strategy]. An Pediatr (Barc) 2018; 89:286-293. [PMID: 29803643 DOI: 10.1016/j.anpedi.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/30/2017] [Accepted: 01/09/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Current guidelines in Spain recommend performing transthoracic echocardiography (TTE) in all children under 2 years of age with a heart murmur. In 2014, the American Paediatric Association published the first appropriate use criteria (AUC) for outpatient paediatric transthoracic echocardiography (TTE) to promote its cost-efficient use. The aim of this article is to analyse the AUC and other clinical factors as predictors of congenital heart disease (CHD) in children less than 2 years of age with a heart murmur, and to develop a safe and efficient referral strategy. PATIENTS AND METHOD Case-control study conducted with children less than 2 years of age, referred from Paediatric Primary Care to Paediatric Cardiology during a 4-year study. A predictive model for CHD was determined using multivariate analysis. RESULTS A total of 688 patients were included, with 129 (19%) cases of CHD. An age less than 3 months (adjusted odds ratio [ORa] 3.8 [1.5-8.4], p=.030) and fulfilling AUC (ORa 16.3 [9.4-28.3], p<.001) were predictors of CHD. Concurrent infection (ORa 0.6 [0.2-0.8], p<.001) and a negative neonatal screening with pulse oximetry (ORa 0.1 [0.05-0.4], p=.001) decreased the risk of CHD. The referral strategy that included these criteria had a 98% sensitivity, 39% specificity, and positive and negative predictive values of 27% and 99%, respectively. It could not diagnose 2% of CHD (all mild), and showed a 32% TTE reduction rate compared to our current strategy. CONCLUSION To refer children less than 3 months old, fulfilling AUC, without a concurrent infection, or without negative neonatal pulse oximetry screening, is a safe and efficient strategy for the management of heart murmur in children under 2 years of age.
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Affiliation(s)
- Moisés Rodríguez-González
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - Almudena Alonso-Ojembarrena
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Ana Castellano-Martínez
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Lorena Estepa-Pedregosa
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Isabel Benavente-Fernández
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Simon P Lubián López
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
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Hussain S, Keat S, Gelding SV. Ketosis-prone diabetes and SLE co-presenting in an African lady with previous gestational diabetes. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170086. [PMID: 29026609 PMCID: PMC5633049 DOI: 10.1530/edm-17-0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 12/02/2022] Open
Abstract
We describe the case of an African woman who was diagnosed with ketosis-prone diabetes with diabetes-associated autoantibodies, after being admitted for diabetic ketoacidosis (DKA) precipitated by her first presentation of systemic lupus erythematosus (SLE). She had a seven-year history of recurrent gestational diabetes (GDM) not requiring insulin therapy, with return to normoglycaemia after each pregnancy. This might have suggested that she had now developed type 2 diabetes (T2D). However, the diagnosis of SLE prompted testing for an autoimmune aetiology for the diabetes, and she was found to have a very high titre of GAD antibodies. Typical type 1 diabetes (T1D) was thought unlikely due to the long preceding history of GDM. Latent autoimmune diabetes of adults (LADA) was considered, but ruled out as she required insulin therapy from diagnosis. The challenge of identifying the type of diabetes when clinical features overlap the various diabetes categories is discussed. This is the first report of autoimmune ketosis-prone diabetes (KPD) presenting with new onset of SLE.
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Affiliation(s)
- S Hussain
- Department of Diabetes and Endocrinology, Newham University Hospital, Barts Health NHS Trust, London, UK
| | - S Keat
- Department of Diabetes and Endocrinology, Newham University Hospital, Barts Health NHS Trust, London, UK
| | - S V Gelding
- Department of Diabetes and Endocrinology, Newham University Hospital, Barts Health NHS Trust, London, UK
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Friedman JM, Couso R, Kitchens M, Vakhshori V, Hillin CD, Wu CH, Steere J, Ahn J, Hume E. Benign heart murmurs as a predictor for complications following total joint arthroplasty. J Orthop 2017; 14:470-474. [PMID: 28831235 DOI: 10.1016/j.jor.2017.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/30/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There is scant literature examining the predictive role of heart murmurs in the absence of suspected structural heart disease on complications of non-cardiac surgery. We hypothesize the detection of heart murmurs in the absence of structural heart disease will help identify patients at risk for complications following total joint arthroplasty (TJA) surgery. METHOD This was a prospective cohort of patients undergoing TJA over a twenty-month period. The study was performed at a single academic institution with four subspecialty surgeons. Patients undergoing primary TJA who were over eighteen years old, gave informed consent, and had adequate documentation were included in the study. Patients with a preoperative murmur or a newly discovered postoperative murmur were compared against patients with no murmur. Surgery-related complications, performance with physical therapy, and discharge to a non-home facility were measured in each group. FINDINGS 345 (63%) eligible patients were included. 20 (5.8%) patients had a documented preoperative murmur and 36 (10.4%) patients had a new postoperative murmur. No patient had concern for major structural heart disease. Preoperative murmurs independently predicted development of acute kidney injury (OR 7.729, p < 0.001; RR 1.36). Preoperative murmurs also predicted likelihood to be discharged to a non-home facility (OR 2.97, p = 0.03; RR 1.87). New postoperative murmurs independently correlated with decreased performance with physical therapy (OR 0.466, p = 0.045; RR 0.664). INTERPRETATION Detection of heart murmurs both preoperatively and postoperatively is a low cost strategy to identify post-TJA surgical patients at risk for postoperative acute kidney injury, decreased physical performance, and discharge to non-home facilities. These patients may benefit from early fluid resuscitation and renally-dosed post-operative medications.
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Affiliation(s)
- James M Friedman
- Department of Orthopedics, University of Pennsylvania, Philadelphia PA, United States
| | - Ricardo Couso
- Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States
| | - Michael Kitchens
- Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States
| | - Venus Vakhshori
- Department of Orthopedics, University of Southern California, Los Angeles CA, United States
| | - Cody D Hillin
- Department of Orthopedics, University of Pennsylvania, Philadelphia PA, United States
| | - Chia H Wu
- Department of Orthopedics, University of Pennsylvania, Philadelphia PA, United States
| | - Joshua Steere
- Department of Orthopedics, University of Pennsylvania, Philadelphia PA, United States
| | - Jaimo Ahn
- Department of Orthopedics, University of Pennsylvania, Philadelphia PA, United States
| | - Eric Hume
- Department of Orthopedics, University of Pennsylvania, Philadelphia PA, United States
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14
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Abstract
BACKGROUND Heart murmurs are common in children and may represent congenital or acquired cardiac pathology. Auscultation is challenging and many primary-care physicians lack the skill to differentiate innocent from pathologic murmurs. We sought to determine whether computer-aided auscultation (CardioscanTM) identifies which children require referral to a cardiologist. METHODS We consecutively enrolled children aged between 0 and 17 years with a murmur, innocent or pathologic, being evaluated in a tertiary-care cardiology clinic. Children being evaluated for the first time and patients with known cardiac pathology were eligible. We excluded children who had undergone cardiac surgery previously or were unable to sit still for auscultation. CardioscanTM auscultation was performed in a quiet room with the subject in the supine position. The sensitivity and specificity of a potentially pathologic murmur designation by CardioscanTM - that is, requiring referral - was determined using echocardiography as the reference standard. RESULTS We enrolled 126 subjects (44% female) with a median age of 1.7 years, with 93 (74%) having cardiac pathology. The sensitivity and specificity of a potentially pathologic murmur determination by CardioscanTM for identification of cardiac pathology were 83.9 and 30.3%, respectively, versus 75.0 and 71.4%, respectively, when limited to subjects with a heart rate of 50-120 beats per minute. The combination of a CardioscanTM potentially pathologic murmur designation or an abnormal electrocardiogram improved sensitivity to 93.5%, with no haemodynamically significant lesions missed. CONCLUSIONS Sensitivity of CardioscanTM when interpreted in conjunction with an abnormal electrocardiogram was high, although specificity was poor. Re-evaluation of computer-aided auscultation will remain necessary as advances in this technology become available.
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15
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Sepehri AA, Kocharian A, Janani A, Gharehbaghi A. An Intelligent Phonocardiography for Automated Screening of Pediatric Heart Diseases. J Med Syst 2016; 40:16. [PMID: 26573653 DOI: 10.1007/s10916-015-0359-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
This paper presents a robust device for automated screening of pediatric heart diseases based on our unique processing method in murmur characterization; the Arash-Band method. The present study modifies the Arash-Band method and employs output of the modified method in conjunction with the two other original techniques to extract indicative feature vectors for the screening. The extracted feature vectors are classified by using the support vector machine method. Results show that the proposed modifications significantly enhances performance of the Arash-Band in terms of the both accuracy and sensitivity as the corresponding effect sizes are sufficiently large. The proposed algorithm has been incorporated into an Android-based tablet to constitute an intelligent phonocardiogram with the automatic screening capability. In order to obtain confidence interval of the accuracy and sensitivity, an inferable statistical test is applied on our database containing the phonocardiogram signals recorded from 263 of the referrals to a hospital. The expected value of the accuracy/sensitivity is estimated to be 87.45 % / 87.29 % with a 95 % confidence interval of (80.19 % - 92.47 %) / (76.01 % - 95.78 %) exhibiting superior performance than a pediatric cardiologist who relies on conventional or even computer-assisted auscultation.
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16
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Abstract
Past decades witnessed the expansion of linear signal processing methods in numerous biomedical applications. However, the nonlinear behavior of biomedical signals revived the interest in nonlinear signal processing methods such as higher-order statistics, in particular higher-order cumulants (HOC). In this paper, HOC are utilized toward heart sound classification. Heart sounds are presented by wavelet packet decomposition trees. Information measures are then defined based on HOC of wavelet packet coefficients, and three basis selection methods are proposed to prune the trees and preserve the most informative nodes for feature extraction. In addition, an approach is introduced to reduce the dimensionality of the search space from the whole wavelet packet tree to a trapezoidal sub-tree of it. This approach can be recommended for signals with a short frequency range. HOC features are extracted from the coefficients of selected nodes and fed into support vector machine classifier. Experimental data is a set of 59 heart sounds from different categories: normal heart sounds, mitral regurgitation, aortic stenosis, and aortic regurgitation. The promising results achieved indicate the capabilities of HOC of wavelet packet coefficients to capture nonlinear characteristics of the heart sounds to be used for basis selection.
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Affiliation(s)
- Fatemeh Safara
- Faculty of Computer Engineering, Islamic Azad University, Islam-shahr Branch, Tehran, Iran.
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17
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Shiue I. Heart murmur and dysrhythmia are associated with accidents leading to poor mental health and cognition: Scottish Health Survey, 2013. Int J Cardiol 2015; 187:322-4. [PMID: 25839636 DOI: 10.1016/j.ijcard.2015.03.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Ivy Shiue
- School of Energy, Geoscience, Infrastructure & Society, Heriot-Watt University, UK.
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18
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Mirzarahimi M, Saadati H, Doustkami H, Alipoor R, Isazadehfar K, Enteshari A. Heart murmur in neonates: how often is it caused by congenital heart disease? Iran J Pediatr 2011; 21:103-6. [PMID: 23056773 PMCID: PMC3446116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 05/05/2010] [Accepted: 06/30/2010] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Congenital heart disease (CHD) is the most common form of cardiovascular diseases in children. This study was performed from September 2006 to August 2007 in Ardebil, Westnorthern Iran. The aim was to determine the prevalence of heart murmur in newborns and its correlation with CHD. METHODS In a 1-year cross sectional descriptive-analytic study, 2928 newborns were screened for heart murmur during routine neonatal physical examination. All babies with murmur underwent echocardiography. FINDINGS Murmur was detected in 91 (3.1%) neonates, of whom 47 (51.6%) had a congenital heart disease. The most common (17.6%) abnormality was ventricular septal defect. Patent ductus arteriosus was found in 10 (11%) patients. CONCLUSION Remarkable high (round 50 %) rate of CDH in newborns presenting with heart murmur, urges to observe these neonates closely to establish the diagnosis of congenital heart disease and early referral to pediatric cardiologist.
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Affiliation(s)
- Mehrdad Mirzarahimi
- Department of Pediatrics, Ardebil University of Medical Sciences, Ardabil, Iran
| | - Hakimeh Saadati
- Department of Physiology, Ardabil University of Medical Sciences, Ardabil, Iran,Corresponding Author: Address: Ardabil university of medical sciences. E-mail:
| | - Hosein Doustkami
- Department of Cardiology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Rogaeh Alipoor
- Department of Pediatrics, Ardebil University of Medical Sciences, Ardabil, Iran
| | - Khatereh Isazadehfar
- Department of Community and Social Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Afsaneh Enteshari
- Department of Internal Medicine, Ardabil university of Medical Sciences, Ardabil, Iran
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