Jugular Pulse Research Articles

Non-contact measurement of neck pulses achieved by imaging micro-motions in the neck skin.

We report a method and system of micro-motion imaging (µMI) to realize non-contact measurement of neck pulses. The system employs a 16-bit camera to acquire videos of the neck skin, containing reflectance variation caused by the neck pulses. Regional amplitudes and phases of pulse-induced reflection variation are then obtained by applying a lock-in amplification algorithm to the acquired videos. Composite masks are then generated using the raw frame, amplitude and phase maps, which are then used to guide the extraction of carotid pulse (CP) and jugular vein pulse (JVP) waveforms. Experimental results sufficiently demonstrate the feasibility of our method to extract CP and JVP waves. Compared with conventional methods, the proposed strategy works in a non-contact, non-invasive and self-guidance manner without a need for manual identification to operate, which is important for patient compliance and measurement objectivity. Considering the close relationship between neck pulses and cardiovascular diseases, for example, CA stenosis, the proposed µMI system and method may be useful in the development of early screening tools for potential cardiovascular diseases.

Clinical and ultrasonographic assessment of traumatic pericarditis and traumatic reticuloperitonitis in buffaloes

Traumatic injury by a foreign body is a common cause of traumatic pericarditis (TP) and traumatic reticuloperitonitis in buffaloes. Both mimics almost the same clinical sign under field conditions. Clinical, hematobiochemical and ultrasonographic changes between TP and TRP cases in buffaloes were evaluated in the present study. From the period of January 2020 to December 2020, a total of twelve buffaloes were investigated with TP and TRP conditions. Six animals each suffering from TP and TRP were included along with six normal healthy animals as control. Different clinical signs, haemato-biochemical parameters and ultrasonographical findings were recorded in each group and comparative analysis was done. Brisket edema in TP affected buffaloes and arch back condition in TRP affected buffaloes was the common clinical finding. Ferroscopy was performed to confirm the location of foreign body. Jugular pulsation was noted in Group II as well as Group III buffalo. A significant increase in WBC count and a significant decrease in hematocrit was noted in Group III animals compared to healthy animals. SGOT and fibrinogen concentration was significantly increased in both group animals. Anechoic fluid accumulation in TP and thickening of the reticular wall in TRP were the most consistent ultrasonographic findings in buffaloes.

Primary cardiac malignant peripheral nerve sheath tumour in a dog

AbstractA 6‐year‐old, female labrador retriever was presented for acute onset abdominal distention. Clinical examination identified tachycardia, a novel grade 3/6 right basilar systolic cardiac murmur, a distended abdomen and ventral pitting oedema. Jugular pulses were not present. Echocardiography revealed an infiltrative, intramural cardiac mass, with partial occlusion of the right atrium and ventricle, resulting in isolated caudal vena cava syndrome. Postmortem examination revealed a large mass arising from the base of the right atrium and extending into the ventricular lumen. Histopathological and immunohistochemical findings were consistent with a diagnosis of malignant peripheral nerve sheath tumour, a rare primary cardiac neoplasm in dogs.

Using changes of left cardiac functional parameters and CPET evaluated the clinical effectiveness of individualized precise exercise overall program management of chronic disease I --Analysis between groups

Objective: To explore and study the clinical usefulness of continuous dynamic recording of left cardiac function changes forevaluation the improvement in patients with chronic disease after 3 months of intensive control of individualized precision exercise overall manage program. Methods: From 2018 to 2021, 21 patients with chronic cardiovascular and cerebrovascular metabolic diseases mainly controlled by our team were selected to complete the cardiopulmonary exercise test (CPET) and Non-invasive synchronous cardiac function detector (N-ISCFD), electrocardiogram, radial pulse wave, jugular pulse wave and cardiogram data were continuously recorded for 50s.According to the titration results under CPET and continuous functional parameters monitoring, a holistic plan with individualized moderate exercise intensity as the core was developed for 3 months of intensive management, and then N-ISCFD data collection was repeatedafter signing the informed consent. All N-ISCFD data were analyzed in the 50s according to the optimal report mode of Fuwai Hospital and 52 cardiac functional indexes were calculated. The data before and after the enhanced control were compared and the paired T-test was used to statistically analyze the changes of groups. Results: Twenty-one patients with chronic diseases (16 male and 5 female) were (54.05±12.77,29~75) years, BMI (25.53±4.04,16.62~31.7) kg/m2.Comparison with baseline,the whole group analysis: ①The body weight, BMI, systolic blood pressure and diastolic blood pressure of patients were significantly decreased(P＜0.01).②CPET Peak VO2 was (64.93±24.22, 26.96~103.48) %Pred before enhanced control, and (85.22±30.31, 43.95~140.48) %Pred after enhanced control, and increased (35.09±27.87, 0.12~129.35) % after enhanced control compared with before enhanced control. The AT, Peak VO2/HR, Peak Work Rate, OUEP, FVC, FEV1, FEV3/FVC% and MVV were significantly increased (P＜0.01) and the Lowest VE/VCO2 and VE/VCO2 Slope were significantly decreased(P＜0.01).③Core indicators of left heart function:Ejection fraction was significantly increased from (0.60±0.12,0.40~0.88) to(0.66±0.09, 0.53~0.87)(P＜ 0.01), by (12.39±14.90,-12.32~41.11)%. The total peripheral resistance was significantly decreased from (1579.52±425.45,779.46~2409.61) G/(cm4·s),to(1340.44±261.49,756.05~1827.01) G/(cm4·s)(P＜0.01), by (12.00±17.27,37.79~28.61) %.The left stroke index, cardiac total power, ejective pressure and left ventricular end diastolic volumewere significantly improved (P＜0.05).The change analysis of each indicator for each patient is shown in the individualized analysis section of this study. Conclusion: Use CPET and continuous functional monitoring we can safely and effectively develop the overall program of individualized exercise in patients with chronic diseases. Long-term intensive management and control can safely and effectively significantly improve the cardiovascular function of patients. Continuous dynamic recording of changes in left and right cardiac functional parameters can be a simple way to supplement CPET to evaluate cardiovascular function.

Reliability of Some Clinical Parameters for Field Diagnosis of African Animal Trypanosomosis in Cattle

Presumptive and inaccurate diagnosis of cattle trypanosomosis among field veterinarians has led to misuse of trypanocides, development of drug resistance, toxicities and huge economic losses. This study assessed the reliability, specificity and sensitivity of some identified trypanosomosis associated signalments (anaemia using FAMACHA® guide, body condition score (BCS), superficial lymph nodes enlargement and jugular pulsation) as field diagnostic parameters. Blood and faecal samples were collected from 273 subjectively selected cattle for the determination of packed cell volume (PCV) and screening for trypanosome, and for helminth egg using McMaster technique, respectively. Data obtained from assessment of packed cell volume based on BCS, FAMANCHA score, superficial lymph nodes enlargement and jugular pulsation were analyzed using descriptive statistics and Chi square, while comparison of data using independent student ttest and one-way ANOVA was similarly conducted. Of the screened cattle, 16.5% (45/273) were positive for trypanosome. Single infection due to Trypanosoma spp. was found in 13.5% (37/273) cattle, while 2.9% (8/273) had trypanosome concurrently with Babesia spp. or helminth infections. The prevalence of Trypanosoma infection was higher in animals with mild or moderately pale mucous membrane, slight emaciation, palpable superficial lymph nodes and pulsating jugular vein. The mean PCV of Trypanosoma infected cattle (27.65±0.056) was lower than in non-infected cattle (31.30±0.36) (p<0.05). Based on the jugular pulsation status, enlargement of the superficial lymph nodes, trypanosomosis state and Famancha category, there was no significant (p<0.05) variation in the PCV of the examined cattle. A negative and low correlation (r = -0.054) existed between BCS and FAMACHA® anaemia score. Each of the clinical diagnostic parameters showed poor sensitivity when employed separately, but the sensitivity improved when applied together and showed 80% specificity to Trypanosoma infection. The results of the present study showed that Trypanosoma infected cattle were associated with anaemia, emaciation, weight loss, jugular pulsation and lymphadenophathy.
 Key Words: Trypanosomosis, Diagnosis, Cattle, Anaemia, Treatment

​Atrial Septal Defect (Secundum Type) in Dogs- A Study for 15 Years

Background: Congenital anomalies in dogs are the defects present at birth and often lead to perinatal death if it involves any vital organ or system like cardiovascular system. Some dogs may remain asymptomatic or may have non cardiac manifestations and hence, undetected until later in life, so the percentage of dogs with congenital heart diseases that survive to adulthood can be rather high. Atrial septal defect (ASD) is an unusual congenital heart disease in dogs that is characterized by communication between the two atria due to a defect in the interatrial septum. Methods: A thorough clinical examination followed by physical examination, thoracic radiography and 2d-echocardiography was performed to determine the septal defect. Doppler evaluation of ASD dogs was carried out to confirm the blood flow direction through the septal defect, which was managed medically. Result: In the present study, ASD (secundum type) was diagnosed in 7 dogs (7.5%) aged between 2y-6y. Boxer, German shepherd, Cocker spaniel, Daschund and Pomeranian were the breeds affected. Soft systolic murmur on left heart base and pulmonic valve area, low intensity heart sounds, distended jugular vein, jugular pulse and ascites were the significant findings on physical examination. Though few dogs (21%) were asymptomatic, exercise intolerance, dyspnoea, general weakness, cough and syncope were the presenting signs among other cases. Enlarged right heart, pleural effusion and pulmonary overcirculation were radiographic findings. 2d-echocardiographic evaluation determined the presence of the defect as a loss of echogenicity at the interatrial septum and presence of interatrial communication of varied size, enlargement of main pulmonary artery and thick atrio-ventricular valves but with normal left atrium:aorta base ratio, increased fractional shortening, systolic function and paradoxal septal motion. The colour flow Doppler study demonstrated a continuous flow with left-to-right shunt.

Inspection of the internal jugular vein pulse appears to be superior to impedance analysis for determination of volemia in a Hyponatremia outpatient clinic

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Clinical - Pathological Aspects of Hepatocellular Carcinoma in Cattle

Background: The hepatocellular carcinoma (HCC) is a malignant neoplasm of hepatocytes of rare occurrence in farm animals, with ruminants being the most affected species. This neoplasm is characterized by nonspecific symptoms and it is etiology in animals has not yet been fully elucidated, although aflatoxin has been shown to be a risk factor in the development this neoplasia. Since hepatic tumors in cattle are commonly incidental findings found in postmortem examination, the objective of this paper is to describe the clinical, laboratory and pathological findings in a cow with this neoplasm.Case: A 5-year-old, adult, Girolando cow weighing 350 kg was referred to the Veterinary Hospital of the Federal University of Recôncavo da Bahia, Brazil, with a history of decreased appetite and weakness for one month. The animal was raised in a semi-intensive system, with a corn-based diet, and regular vaccination. Futhermore, was not treated at the farm of origin and three days before being admitted to the hospital, began to present edema of the dewlap. On examination at our center, the cow was in lean, active, with mucupurulent secretion in nostrils; ocular conjunctiva edema; and edema of the dewlap. The cow had neutrophilia, hypofibrinogemia, hypoproteinemia, and trombocytopenia. It also had tachycardia, tense abdomen, engorgement of the vessels of the face and jugular veins, stasis test and bilaterally positive jugular pulse. Although evidence of pain in reticulum was negative in the examination, the initial diagnostic suspicion established was of traumatic reticular pericarditis. The therapeutic protocol instituted was daily monitoring, flunixin meglumine and flofernicol. The examination of rectal palpation revealed in the right flank an irregular-sized parenchymal structure with enlarged and palpacion in pain. Thus, by location and texture, it was suspected that the structure in question was a liver or kidney. However, the dosage of creatinine ruled out renal damage, and persistent hypoproteinemia reinforced the suspicion of hepatic impairment. In view the deterioration of the clinical condition and the suspicion of hepatic impairment, such as hepatic insufficiency, hepatitis or hepatic abscess, we opted for a right exploratory laparotomy. The surgery confirmed the presence of various granulomas throughout the liver, a non-luster organ, bulging edges with erosions and deposition of fibrin on the surface, confirming liver dysfunction. However, the animal died during the surgical procedure, and necropsy was performed, evidencing a focally extensive mass and multiple nodules of various sizes in the liver, lymph nodes and lung. In the microscopy of these nodules, cells similar to hepatocytes were observed, arranged in the form of strands or in agglomerates. Thus, similar to the reports in the literature, the diagnosis of HCC was carried out postmortem by necropsy and histopathology.Discussion: The diagnosis of HCC was based on clinical, laboratory and anatomopathological findings. The hypoproteinemia and persistent hypofibrinogenemia suggest a hepatic dysfunction that was confirmed on surgery and histopathology. Primary liver tumors, although rare in production animals, must be considered in the differential diagnosis of weight loss, weakness and edema in cattle. It was not possible to determine the etiology of the neoplasia in this case, however, the possibility of aflatoxicosis by corn should not be ruled out as a probable inducer, since corn was a constituent of the diet provided to the animal.

In‐hospital development of an aorto‐cardiac fistula in a Warmblood gelding with chronic renal disease

SummaryA 20‐year‐old Warmblood gelding presented for evaluation and treatment of ventral oedema and azotaemia of unknown aetiology. On presentation, a diastolic heart murmur was appreciated and echocardiography revealed moderate aortic insufficiency due to chronic degenerative valve disease. The horse was hospitalised and failed to respond to oral and i.v. fluids and diuretics. Following discontinuation of all fluid and diuretic therapy, the horse became acutely agitated and developed monomorphic ventricular tachycardia. The ventricular tachycardia spontaneously converted to normal sinus rhythm, however the heart murmur changed in timing to a right basilar continuous murmur and bounding jugular pulses were noted. Repeat echocardiogram revealed an aorto‐cardiac fistula with dissection into the basilar interventricular septum and left‐sided chamber volume overload that was not previously present. Attempts at stabilisation were unsuccessful and euthanasia was elected. Post‐mortem examination confirmed chronic renal disease of unknown aetiology in addition to an aorto‐cardiac fistula originating from the right sinus of Valsalva with subsequent dissection into the basilar interventricular septum.

The Diagnostic Approach to the Patient with Hyponatremia: Are the Correct Investigations Being Done?

Numerous observational studies have confirmed that inadequate investigation of hyponatremia leads to diagnostic errors and incorrect treatment. In fact, only one out of five patients diagnosed as having syndrome of inappropriate antidiuresis (SIAD) have had all the tests necessary to meet the diagnostic criteria. Diagnostic errors could help explain why a majority of patients presenting hyponatremia during hospitalization are discharged while still hyponatremic. The correct differentiation of hypovolemic from euvolemic patients is a clinical diagnostic challenge. Yet the value of the physical examination in the volemic classification of the patient with hyponatremia has been reinforced by ultrasound studies revalidating the utility of the measurement of internal jugular vein pulse height in the clinical evaluation of intravascular volume. In this chapter, we review the data available on current approaches to the diagnosis of hyponatremia, and suggest our recommended approach to the evaluation of patients with hyponatremia, and more specifically, patients with SIAD. In addition, we will explore how specialized input from multidisciplinary hospital "hyponatremia teams," supported by technologies such as automated electronic alert systems, and computerized physician-support systems can aid the diagnostic pathway and clinical care delivery for patients with hyponatremia.

Impact of right ventricular distensibility on congestive heart failure with preserved left ventricular ejection fraction in the elderly.

To elucidate involvement of age-related impairments of right ventricular (RV) distensibility in the elderly congestive heart failure (CHF), we examined the prevalence of less-distensible right ventricle in patients with preserved left ventricular ejection fraction (LVEF) over a wide range of ages. In 893 patients aged from 40 to 102years, we simultaneously recorded electrocardiogram, phonocardiogram, and jugular venous pulse wave. Using signal-processing techniques, the prominent 'Y' descent of jugular pulse waveform was detected as a hemodynamic sign of a less-distensible right ventricle. Prevalence of less-distensible right ventricle and elevated RV systolic pressure increased along with aging from the 50s to the 90s in an exponential fashion from 3.3 and 12% up to 33 and 61%, respectively (p<0.001 for each). This age-dependent deterioration of ventricular distensibility was not observed for the left ventricle. Higher age and higher RV systolic pressure were independently associated with less-distensible right ventricle (Odds ratio, 1.05 per 1year, p=0.003; and 1.03 per 1mmHg, p=0.026, respectively). The elderly CHF was associated with high prevalence of the less-distensible right ventricle and higher RV systolic pressure, both of which were independent risk factors for CHF (Odds ratio, 5.27, p=0.001, and 1.08 per 1mmHg, p<0.001, respectively). In elderly patients with preserved LVEF, the combination of a less-distensible right ventricle and a high RV systolic pressure seems to be related to developing CHF. The less-distensible right ventricle and elevated RV systolic pressure are closely associated with CHF with preserved LVEF in the elderly patients.

Diaphragmatic herniation of reticulum in a hardware disease of cow

Diaphragmatic reticular hernia was diagnosed in a seven year old cow during necropsy examination. Clinically, cow showed decreased appetite, progressive weakness, intermittent fever, jugular pulse, lethargy, recurrent bloat and arching of back from one month. The clinical signs aggravated and cow showed fever, ruminal atony, submandibular edema, watery diarrhoea and impaction for four days and recumbency for 12 hours before death. A forked metal wire was recovered from reticulum which caused traumatic reticulitis leading to diaphragmatic rupture and reticular herniation into the thoracic cavity through ruptured diaphragm, pericarditis with adhesion to rib cage and pneumonia leading to death. Histopathological study of affected organs showed fibrinous pericarditis, epicardial haemorrhages, acute fibrinous interstitial pneumonia, cirrhosis and enteritis.

Second-degree atrioventricular block in a diarrheic calf-camel (Camelus dromedarius)

Atrioventricular block (AVB) is a type of heart block in which the conduction between the atria and ventricles of the heart is impaired. The purpose of the present paper is to report the occurrence of second-degree AVB in a diarrheic calf-camel. A 7-day-old female calf-camel (Camelus dromedarius) weighting approximately 50 kg was referred to the veterinary hospital with a 5-day history of diarrhea, prostration, tremors, sternal recumbency, and muscular weakness. Clinical examination revealed increases in rectal temperature (RT 39.9 °C), heart rate (HR 124 beats min−1), and respiratory rate (RR 49 breaths min−1) with hyperemic mucous membranes. Incidentally, in precise cardiac auscultation, the clinicians found out irregularities in the rhythm and recognized the random absence of S1 and S2 heart sounds. Moreover, no palpable pulse and jugular pulsation (JP) could be detected during the cardiac irregularities. Other clinical examinations showed no sign of cardiovascular insufficiency such as edema and jugular distension (JD) and no murmur was auscultated. Before the treatment, serum levels of magnesium were significantly lower than the reference values, while the concentration of potassium was significantly higher than the reference value (P 0.05). Based on the cardiovascular examination (observation, palpation, and auscultation), heart block was suspected. ECG recording confirmed the presence of sinus arrhythmia (SA) and heart block including first-degree and Mobitz type 1 (Wenkebach) second-degree. Finally, since the AVB was resolved after correction of serum electrolyte imbalance, it can be suggested that electrolyte disturbance was the main cause of Mobitz I second-degree AVB in the above described diarrheic calf-camel.

Racing heart and pounding neck: Classic clinical sign revisited

Abstract The present report describes “Frog sign” due to prominent jugular pulsations in the neck. This is seen in case of paroxysmal atrioventricular nodal reentrant tachycardia.

Clinical presentation and ultrasonographic findings in buffaloes with congestive heart failure

The objective of this retrospective study was to describe the clinical presentation and ultrasonographic findings in water buffaloes suffering from congestive heart failure. Fifty-three buffaloes with congestive heart failure, which was confirmed postmortem, were included. The final diagnoses were traumatic pericarditis (n = 38) and vegetative endocarditis (n = 15). Ten healthy buffaloes were enrolled in this study as controls. The main clinical presentations were those related to right-sided congestive heart failure including peripheral edema, venous distension and jugular pulsation, and a sharp drop in milk yield. Only 5 buffaloes exhibited signs of left-sided heart failure. Ultrasonographic examinations showed cardiac and extracardiac lesions. Accumulation of massive anechoic fluids in the pericardial sacs, peritoneum, and pleura represented pericardial, peritoneal, and pleural effusions, respectively. In buffaloes with endocarditis, the affected valves appeared as hyperechogenic thick mass structures with nodular or proliferative vegetative lesions. Small ( 25 mm) vegetative lesions were imaged. The most affected valve was the tricuspid (n = 8), then the mitral (n = 5) and pulmonary (n = 2). In addition, perireticular abscesses, hepatomegaly, dilated caudal vena cava, and lung consolidations were also imaged. In conclusion, the prognosis seemed poor. Ultrasonography may be helpful in the evaluation of lesions in buffaloes with congestive heart failure.

A High Prevalence of Less-Compliant Right Ventricle in Elderly Cardiac Patients

The pathophysiology of the elderly heart failure is poorly understood. We examined the prevalence of less-compliant right ventricle (RV) to clarify whether venous congestion in the elderly is related to stiffening of the RV. The less-compliant RV was defined by the typical non-compliant pattern (a prominent Y descent and H wave corresponding to a dip and plateau of the RV pressure) of jugular pulse in 1058 cardiac patients. Less-compliant RV under 35 years old was related to cardiac surgery. With aging from 60 to > 90 years, however, the prevalence of less-compliant RV rose substantially from 8 % to 43% independently of cardiac surgery, suggesting that the age-related progression of RV stiffening could result the restriction to RV filling and venous congestion in the elderly cardiac patients.

E-003 Endovascular Embolisation of Paediatric High-Flow Vertebral Arteriovenous Fistula: Association with Intracranial Steal and the Importance of Post-procedural Management

Purpose and BackgroundHigh-flow vertebral artery arteriovenous fistula (VAVF) and concurrent steal from intracranial arteries or contralateral vertebral artery is a well-known phenomenon. Cardiovascular and/or neurological complications following the occlusion of...

Malignant peripheral nerve sheath tumor as a cause of chronic cardiac insufficiency in cattle

Chronic cardiac insufficiency was associated with a malignant peripheral nerve sheath tumor in a cow. An eight-year-old cow developed a progressive condition (over a period of three months) characterized by an enhanced abdominal volume, reluctance to move, a positive jugular pulse, watery diarrhea and death. At necropsy, moderate subcutaneous edema and an enhanced hepatic lobular pattern were observed. A 23x20x11 cm firm, grayish-white mass adhered to and infiltrated the right atrium. Multiple firm, yellowish-white nodules of 0.5 to 12 cm in diameter were diffusely scattered in the epicardium and parietal pericardium. Histologically, the tumor was poorly circumscribed with foci of infiltration of the myocardium. The neoplastic cells had two major histologic patterns, Antoni types A and B. Within occasional foci, pleomorphic cells with an epithelioid appearance were present in addition to multinucleated cells with periodic acid Schiff (PAS)-positive cytoplasmic globules. Foci of cartilaginous and granular differentiations were interspersed among the neoplastic cells. Multiple vessels presented wall hyalinization and tumoral embolus. Large necrotic foci with mineralization and cholesterol clefts were also observed. Immunohistochemically, the tumor was positive for S100 protein, vimentin and neuron-specific enolase labeling.

Use of Procainamide for Conversion of Acute Onset AF Following Pericardiocentesis in a Dog

A 9 yr old spayed female golden retriever was evaluated for anorexia and suspected gastric dilatation. Subsequent evaluation the following day determined the dog to have pericardial effusion. Muffled heart sounds and jugular pulses were noted on physical exam, and the dog was diagnosed with pleural and pericardial effusion. A sinus rhythm with a rate of 142 beats/min was documented on a surface electrocardiogram (EKG). Following pericardiocentesis, the heart rate increased to 260 beats/min, the rhythm became irregular, and the systemic blood pressure decreased. Atrial fibrillation (AF) was confirmed by EKG. Procainamide was administered IV over 15 min, resulting in successful conversion of AF to sinus rhythm and clinical improvement. Procainamide is one of several antiarrhythmic medications that are used for the conversion of acute AF in humans; however, its utility and efficacy in dogs in the setting of AF has not previously been reported. This case highlights a unique complication of performing a pericardiocentesis that requires immediate treatment and describes a potential treatment option for the conversion of acute AF in dogs.

Primary cardiac lymphoma in a 10-year-old equine gelding

PRIMARY cardiac lymphoma (PCL) is a rare tumour in all species (Sims and others 2003, Shinohara and others 2005, Miguel and Bestetti 2011, Petrich and others 2011) affecting the myocardium...