Audible Heart Sounds Research Articles

Wearable pulmonary monitoring system with integrated functional lung imaging and chest sound recording: a clinical investigation in healthy subjects

Objective. Current wearable respiratory monitoring devices provide a basic assessment of the breathing pattern of the examined subjects. More complex monitoring is needed for healthcare applications in patients with lung diseases. A multi-sensor vest allowing continuous lung imaging by electrical impedance tomography (EIT) and auscultation at six chest locations was developed for such advanced application. The aims of our study were to determine the vest’s capacity to record the intended bio-signals, its safety and the comfort of wearing in a first clinical investigation in healthy adult subjects. Approach. Twenty subjects (age range: 23–65 years) were studied while wearing the vests during a 14-step study protocol comprising phases of quiet and deep breathing, slow and forced full expiration manoeuvres, coughing, breath-holding in seated and three horizontal postures. EIT, chest sound and accelerometer signals were streamed to a tablet using a dedicated application and uploaded to a back-end server. The subjects filled in a questionnaire on the vest properties using a Likert scale. Main results. All subjects completed the full protocol. Good to excellent EIT waveforms and functional EIT images were obtained in 89% of the subjects. Breathing pattern and posture dependent changes in ventilation distribution were properly detected by EIT. Chest sounds were recorded in all subjects. Detection of audible heart sounds was feasible in 44%–67% of the subjects, depending on the sensor location. Accelerometry correctly identified the posture in all subjects. The vests were safe and their properties positively rated, thermal and tactile properties achieved the highest scores. Significance. The functionality and safety of the studied wearable multi-sensor vest and the high level of its acceptance by the study participants were confirmed. Availability of personalized vests might further advance its performance by improving the sensor-skin contact.

The quality, understandability, readability, and popularity of online educational materials for heart murmur.

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. 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. 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). 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.

Non-perfusing cardiac rhythms in asphyxiated newborn piglets.

AimWe recently demonstrated that asphyxiated piglets commonly had bradycardia displayed on electrocardiography (ECG) while no carotid blood flow (CBF) or audible heart sounds could be detected. Such pulseless electrical activity (PEA) in newborn infants has not previously been thoroughly described. The aim of this study was to further investigate the occurrence of non-perfusing cardiac rhythms in asphyxiated piglets and the potential implications for the success of cardiopulmonary resuscitation (CPR) and short-term survival.MethodsNeonatal piglets (1–4 days, 1.7–2.4kg) had their right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe. Heart rate (HR) was continuously measured and recorded using ECG. This allowed simultaneous monitoring of HR via ECG and CBF. The piglets were asphyxiated until cardiac arrest, defined as no CBF and no audible beat upon precordial auscultation. CPR was performed until return of spontaneous circulation (ROSC, defined as a HR ≥100 bpm). ECG traces were retrospectively assessed.ResultsNine out of 21 piglets (43%) had QRS-complexes on their ECG while no CBF and no audible heart sounds could be detected. Five (56%) of the piglets with PEA and 12/12 (100%) piglets with asystole at cardiac arrest obtained ROSC (p = 0.02). Thirty-three per cent of the piglets with PEA versus 58% with asystole survived to 4 hours post-ROSC (p = 0.39).ConclusionCardiac arrest in the presence of a non-perfusing cardiac rhythm on ECG is common in asphyxiated piglets. Clinical arrest in the presence of a non-perfusing cardiac rhythm on ECG may reduce the success of CPR.

Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants.

Background: In 2015, the neonatal resuscitation guidelines incorporated the use of electrocardiography (ECG) to monitor heart rate of newborns. However, previous studies have indicated that cardiac arrest with pulseless electrical activity rhythm (PEA) may occur in the delivery room, rendering this method problematic.Objective: To evaluate the accuracy of ECG and auscultation to assess heart rate during PEA.Methods: A total of 45 piglets (age 1–3 days, weight 1.7–2.3 kg) were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. During asphyxia, heart rate (HR) was assess using auscultation, ECG, and carotid blood flow (CBF). At the time of asystole (defined as zero CBF) HR auscultated using a neonatal/infant stethoscope was compared to ECG traces.Results: The median (IQR) duration of asphyxia was 325 (200–491) s. In 8 (18%) piglets, CBF, ECG, and auscultation identified asystole. In 22 (49%) piglets no CBF and no audible heart sounds, were observed, while ECG displayed a HR ranging from 17 to 75/min. Fifteen (33%) piglets remained bradycardic (defined as HR of < 100/min) after 10 min of asphyxia, which was identified by CBF, ECG, and auscultation. The overall accuracy of ECG and auscultation in the detection of HR were 51 and 80%, respectively (p = 0.004).Conclusion: In cases with PEA ECG is not superior in correctly identifying HR in newborn piglets.

Pulseless electrical activity: a misdiagnosed entity during asphyxia in newborn infants?

BackgroundThe 2015 neonatal resuscitation guidelines added ECG as a recommended method of assessment of an infant’s heart rate (HR) when determining the need for resuscitation at birth. However, a recent...

Cardiac-induced localized thoracic motion detected by a fiber optic sensing scheme.

The cardiovascular health of the human population is a major concern for medical clinicians, with cardiovascular diseases responsible for 48% of all deaths worldwide, according to the World Health Organization. The development of new diagnostic tools that are practicable and economical to scrutinize the cardiovascular health of humans is a major driver for clinicians. We offer a new technique to obtain seismocardiographic signals up to 54 Hz covering both ballistocardiography (below 20 Hz) and audible heart sounds (20 Hz upward), using a system based on curvature sensors formed from fiber optic long period gratings. This system can visualize the real-time three-dimensional (3-D) mechanical motion of the heart by using the data from the sensing array in conjunction with a bespoke 3-D shape reconstruction algorithm. Visualization is demonstrated by adhering three to four sensors on the outside of the thorax and in close proximity to the apex of the heart; the sensing scheme revealed a complex motion of the heart wall next to the apex region of the heart. The detection scheme is low-cost, portable, easily operated and has the potential for ambulatory applications.

A 50-year-old woman with syncope

A 50-year-old postmenopausal woman with no prior comorbidity, was brought to the emergency department with two weeks history of exertional dyspnoea, syncope and generalised weakness. There was no associated chest pain or cough. She had experienced three episodes of syncope characterised by loss of consciousness, each episode lasting for 2–3 mins. On examination, she was a middle-aged woman with a pulse of 100 beats·min−1, blood pressure of 120/80 mmHg, respiratory rate of 20 breaths·min−1, room air oxygen saturation of 95% and jugular venous pressure within the normal range. Leg veins were prominent with minimal pedal oedema. Respiratory examination revealed an elliptical chest, normal vesicular breathing and occasional wheeze. Cardiovascular examination revealed a right ventricular heave, audible heart sounds with a systolic murmur audible at the tricuspid area and palpable peripheral pulses. The chest radiograph (CXR) from a local hospital is shown in figure 1. Figure 1 Chest radiograph. ### Task 1 What does the chest radiograph demonstrate? ### Answer 1 An electrocardiogram (EKG) revealed right ventricular strain with no evidence of an acute coronary episode. Initial investigations at our hospital showed a haemoglobin level of 14.9 mg·dL−1 (11.5–13.8 mg·dL−1), total white cell count of 13.2×109 cells·L−1 (4.0–10.0×109 cells·L−1) and platelets of 174×109 cells·L−1 (150–400×109 cells·L−1). Arterial blood gases showed pH 7.53, oxygen tension 65.9, carbon dioxide tension 27.2, HCO3- 22.7 …

Chronic Constipation with Megacolon

A 61-year-old female with long-standing constipation presented with increasing abdominal distention, pain, nausea and weight loss. She had been previously treated with intermittent fiber supplements and osmotic laxatives for chronic constipation. She did not use medications known to cause delayed bowel transit. Examination revealed a distended abdomen, hard stool in the rectum, and audible heart sounds throughout the abdomen. A CT scan showed severe colonic distention from stool (Fig. 1). She had no mechanical, infectious, metabolic, or endocrine-related etiology for constipation. After failing conservative management including laxative suppositories, enemas, manual disimpaction, methylnaltrexone and neostigmine, the patient underwent a colectomy with Hartmann pouch and terminal ileostomy. The removed colon measured 25.5 cm in largest diameter and weighed over 15 kg (Fig. 2). The histopathological examination demonstrated no neuronal degeneration, apoptosis or agangliosis to suggest Hirschprung’s disease or another intrinsic neuro-muscular disorder. Idiopathic megacolon is a relatively uncommon condition usually associated with slow-transit constipation. Although medical therapy is frequently ineffective, rectal laxatives, gentle enemas, and manual disimpaction can be attempted. Oral osmotic or secretory laxatives as well as unprepped lower endoscopy are relative contraindications as they may precipitate a perforation. Surgical therapy is often required as most cases are refractory to medical therapy. Figure 1 CT scan showing severe colonic distention from stool. Figure 2 Surgical specimen (colon).

Spontaneous Intramural Esophageal Hematoma in Association With Idiopathic Thrombocytopenic Purpura: A Cause of Non-Cardiac Chest Pain

An 81-year-old man presented to the Emergency Department with severe acute onset epigastric and retrosternal chest discomfort with dysphagia coincident with the consumption of a small meal. His medical history was notable for chronic idiopathic thrombocytopenic purpura (ITP) as well as a remote history of a prior cardiac arrest with pacemaker/defibrillator implantation. There was no significant premorbid history of upper gastrointestinal or general constitutional symptomatology. Physical examination was unremarkable aside from audible heart sounds in the epigastrum and moderate epigastric tenderness to palpation.

Instantaneous nonarrhythmic cardiac death in acute myocardial infarction

From a group of 663 patients with acute myocardial infarction, 15 patients were identified with the syndrome of sudden loss of consciousness not preceded by symptoms of cardiac or respiratory failure or cardiac arrhythmias. The syndrome was accompanied by normal sinus rhythm, as assessed by electrocardiogram, but by neither a palpable pulse nor audible heart sounds. Seven of these patients had postmortem studies, and clinicopathologic correlations are presented. This syndrome has accounted for 68 percent of in-hospital monitored sudden deaths due to myocardial infarction. Four possible mechanisms are reviewed. These patients are presented to identify the problem of nonarrhythmic cardiac arrest in acute myocardial infarction and to stimulate new thoughts concerning etiology and management.

Survival Rate After Cardiac Arrest in a Community Hospital

THIS STUDY consists of a six-month survey (Aug 1, 1964, to Jan 31, 1965) of attempts at resuscitation of patients in whom cardiac arrests developed at onset or during the course of their illness. All attempts at resuscitation were done at Muhlenberg Hospital, Plainfield, NJ, a 550-bed community hospital serving a wide residential area of Union, Somerset, and Middlesex counties. Certain criteria for the diagnosis of cardiac arrests were established, as well as extent of adequate attempt at cardiac resuscitation. <h3>Criteria for Cardiac Arrests.—</h3> (1) Clinical evidence has been obtained through examination of the patients by at least three competent observers, who found the patient to have no audible heart sounds; no blood pressure, respiration, and pulse;dilated pupils; and pallor with or without cyanosis. (2) There is electrocardiographic evidence of cardiac standstill or ventricular fibrillation. <h3>Criteria for Adequate Attempt at Resuscitation. —</h3> Continuous or active external cardiac massage

ELECTROCARDIOGRAPHIC STUDIES OF THE DYING HUMAN HEART

Electrocardiography has increased our knowledge of the human heart in health and disease. Its usefulness does not end here, for we may proceed further and investigate the heart in the last moments of life and even after life has apparently ceased. The phenomena of clincal death, as manifested by the cessation of respiration and audible heart sounds, have been observed repeatedly. That cardiac activity does not cease simultaneously with clinical death and that, in certain instances, it continues for a prolonged period is best revealed by the electrocardiograph. Since the original work of Rhomer1in 1911, various observers2have described the sequence of events occurring in electrocardiograms taken during the last moments of life. Turner,3in a recent review of the literature, collected sixty-five cases in which electrocardiograms were taken during death. To this series he added five cases. We are reporting in abstract twenty cases in