Muffled Heart Sounds Research Articles

Tension Pneumopericardium Caused by Pericarditis

A 60-year-old man, admitted to our thoracic surgery department with complaint of dyspnea and fever, which had been aggravated for the past 10 days. On arrival, he was fully conscious and alert, but very distressed and could not lie supine comfortably. His vital signs were a pulse rate of 125 beats per minute, blood pressure of 130/50 mm Hg, respiratory rate of 35 breaths per minute, and temperature of 38.8°C. Laboratory examinations were within normal ranges except WBC 9.91 x 109/L, N = 79.8%. On examination he had distended neck veins, muffled heart sounds and a palpable pulsus paradoxus.

Pulmonary hypertension and right-sided heart failure in an adult llama with hepatic disease

A 13-year-old llama was examined because of lethargy, inappetence, and syncope. Physical examination revealed muffled heart and lung sounds and peripheral edema. Clinicopathologic abnormalities included lymphopenia, hyperglycemia, prerenal azotemia, mild hyponatremia, mild hypoalbuminemia, and high gamma-glutamyltransferase and creatine kinase activities. On ultrasonography, the liver appeared hyperechoic and ascites and pleural effusion were seen. Echocardiography revealed severe dilatation of the right atrium, right ventricle, and pulmonary artery; severe tricuspid regurgitation; and high right ventricular systolic pressure consistent with right-sided heart failure secondary to pulmonary hypertension. Treatment with furosemide was attempted, but because of failing health, the llama was euthanized 4 weeks later. Macronodular cirrhosis of the liver, glomerulonephritis, and intimal fibrosis and medial hypertrophy of muscular pulmonary arteries were seen on histologic examination of postmortem specimens. Findings in this case were similar to those reported for human patients with portopulmonary hypertension secondary to hepatic cirrhosis. Pulmonary hypertension secondary to hepatic disease should be considered in the differential diagnosis of right-sided heart failure.

A CASE REPORT OF THE TRANSPORT OF AN INFANT WITH A TENSION PNEUMOPERICARDIUM

Neonatal pneumopericardium is a potentially fatal complication of positive-pressure ventilation and has become rare with the advent of surfactant replacement therapy. The clinical diagnosis, stabilization, treatment, and nursing care of an infant with pneumopericardium has not previously been discussed in the nursing literature. In this case report, delays in the recognition and definitive treatment of the pneumopericardium were encountered, resulting in the transport of an infant with a tension pneumopericardium and pneumoperitoneum. Root-cause analysis is used to identify contributing factors and examine system changes necessary to prevent the transport of another patient with a similar potentially life-threatening condition. Pneumopericardium should be suspected in any infant with an acute deterioration, especially in the presence of normal, equal breath sounds and muffled heart sounds, because prompt recognition and definitive treatment may be life-saving.

Right Coronary Perforation Due to a Toothpick Ingested at a Barbecue

To the Editor: Ingested toothpicks have often been reported as the cause of gastrointestinal injuries,1 and in one case a toothpick migrated into the pericardium, resulting in constrictive pericarditis.2 We report an unusual case of cardiac tamponade due to an ingested toothpick. A 67-year-old woman with no pertinent medical history presented to the emergency department with chest pain and signs of cardiac tamponade (muffled heart sounds, low blood pressure, and vasoconstriction). The electrocardiogram showed Q waves in leads II, III, and aVF. The creatine kinase concentration was 736 U per liter (normal reference range, 20 to 160 U per liter), . . .

Idiopathic pericarditis and cardiac tamponade in two cows

Idiopathic pericarditis is an uncommon diagnosis in cattle with cardiac tamponade. Two cows were examined for clinical signs of right-sided congestive heart failure, including tachycardia, venous distention, and peripheral edema. Muffled heart sounds were detected in one of the cows. Echocardiography in both cows revealed voluminous anechoic pericardial effusion and compression of the right atrium and right ventricle. Cytologic analysis of the pericardial fluid revealed hemorrhagic inflammation but no evidence of a septic or neoplastic condition such as traumatic reticulopericarditis or lymphoma, respectively. Pericardial drainage and lavage accompanied by treatment with anti-inflammatory drugs were curative in both cows. It is important to differentiate cows with idiopathic pericarditis from cows with more common septic pericarditis because the prognosis for the former disease appears to be good with appropriate treatment.

Echocardiography

Echocardiography is the pivotal diagnostic modality for assessing the clinical significance of a heart murmur in horses. The echocardiographic examination can be used to identify the etiology of a heart murmur, determine the severity of the underlying disease that is present, and assess its potential impact on the horse’s performance and life expectancy. The echocardiographic examination is also the cornerstone of the diagnosis of endocarditis, pericarditis, and myocardial dysfunction in horses. An echocardiographic examination is indicated in horses with loud systolic murmurs, holodiastolic murmurs, continuous murmurs, muffled heart sounds, pericardial friction rubs, and in horses with exercise intolerance or poor performance.

Successful Treatment of Pericarditis in a Pregnant Llama

Abstract Objective: To describe the diagnosis and treatment of a pregnanat llama with perticardlts. Summary: A 2‐year‐old female llama presented for lethargy of several days' duration. Partinent physical examination findings included tachycardia. muffled heart sounds, tachpnea and lethargy. Electrocardiography revealed tachycardia, second‐degree AV block and electrical alternans. Echocardiography confirmed the presence of pericardial effusion and cardiac compromise. Thoracic sonogram revealed pleural effusion. Treatment included intravenous fluids, systemic antimicrobials, systemic anti‐inflammatories, thoracocentesis and eventual pericardiocentesis with daily drainage and lavage. No etiological agent was identified. The llama reponded well to therapy well to therapy and a 3.5‐month and 2‐year follow‐up revealed no cardiac problems. New information provided: This is the first case report of pericarditis in a llama with treatment and a favorable outcome.

Ultrasonographic diagnosis: cranial vena cava thrombosis in a cow.

A 5-year-old Hereford cow was donated to Oregon State University, College of Veterinary Medicine. Two weeks before presentation the cow was treated by a left-flank laparotomy to correct a uterine torsion that revealed an excessive amount of abdominal fluid and a full term dead fetus. Ultrasonographic evaluation of the right cranioventral thoracic cavity was performed owing to physical examination (muffled heart sounds, areas of silence) and thoracocentesis findings suggestive of pleuritis. Ultrasonography revealed hypoechoic pleural effusion and a mass of mixed echogenicity visible within the right atrial lumen extending into the cranial vena cava. A diagnosis of cranial vena cava thrombosis was demonstrated at necropsy. The clinical, ultrasonographic, and pathological features of this less common condition (cranial vena cava thrombosis) in cattle are discussed.

Purulent pericarditis: clinical profile and outcome following surgical drainage and intensive care in children in Chandigarh.

Purulent pericarditis, though rare in developed countries, is not uncommon in developing countries. However, the type of pericardial drainage required and the risk of subsequent constrictive pericarditis has not been clearly defined. Thirty children between the ages of 3 months and 12 years with a diagnosis of purulent pericarditis were studied retrospectively. Pericardial effusion was confirmed in all by echocardiography and the diagnosis of bacterial pericarditis was based on aspiration of purulent fluid with leucocytosis and high proteins. Purulent pericarditis was a part of the disseminated sepsis in 25 (83%) children. Fever was present in all, hepatomegaly in 28 and breathlessness in 25, whereas muffled heart sounds, raised JVP and pericardial rub were found in only 18, 16 and 7, respectively. The ECG was abnormal in only 16 children. Staphylococcus aureus was the causative organism in 24 (96%). Open surgical drainage was done in 26 children, 23 of whom underwent anterior pericardiectomy. Two children died of disseminated sepsis. None of the 21 who returned for follow-up for periods of between 4 and 24 months had any long-term sequelae.

A swollen swimmer

In November, 1997, a 38-year-old former UK swimming international presented with a history of intermittent angioedema involving his face, neck, and limbs. This was associated with wheezing. A diagnosis of late-onset asthma had already been made. His treatment had been daily bronchodilators and up to seven courses of oral corticosteroids per year for the preceding 5 years. In addition, at the age of 27 he had had an unexplained “autoimmune illness”, for which he had been treated with corticosteroids at another hospital. Physical examination was normal with the exception of a forced expiratory wheeze. No cause could be found for his angioedema in his medication, specific allergic stimulus, or defect or deficiency in C1-inhibitor activity. He had eosinophilia (eosinophils 2·4 10/L, 19% of total white-cell count). He was treated with tranexamic acid and prophylactic antihistamines with substantial improvement. Corticosteroids were withdrawn. 6 months later his angioedema recurred, affecting sites of minor trauma and occurring after sexual activity. He also complained of malaise, and examination showed cardiomegaly and muffled heart sounds. A moderate pericardial effusion with severe left-ventricular dysfunction was confirmed by echocardiography. He was admitted for investigation. On further questioning he denied any history of alcohol or drug abuse, and specifically denied use of anabolic steroids or leukotriene antagonists. Peripheral-blood eosinophilia was again found. While in hospital he had an episode of severe bronchospasm, associated with moderate hypoxaemia, and transient patchy pulmonary infiltrates on his chest radiograph. He responded to treatment with corticosteroids, aminophylline, and bronchodilators.

Pericarditis in horses: 18 cases (1986–1995)

Objective To determine clinical signs of pericarditis in horses and to determine whether there were any relationships among clinical signs, echocardiographic findings, treatment, and outcome. Design Retrospective study. Animals 18 horses. Results Physical examination was performed on 16 horses. Cardiovascular abnormalities included tachycardia (n = 16), pericardial friction rub (10), venous distention (7), murmur (7), muffled heart sounds (6), weak arterial pulse (6), jugular pulse (6), and edema (5). Twelve horses also had respiratory abnormalities; the most common was dull lung sounds, ventrally, suggestive of pleural effusion (10). Echocardiography was the most important tool for diagnosis of pericarditis. Detection of clinical signs of right-sided heart failure was significantly associated with severe accumulation of pericardial effusion and with detection of cardiac compromise. Severe accumulation of pericardial effusion was also significantly associated with echocardiographic detection of cardiac compromise. Pericarditis was idiopathic in 6 horses, and bacterial in 5. Five horses had nonseptic pericarditis associated with bacterial respiratory disease, and 2 had nonseptic pericarditis associated with viral respiratory disease. Fourteen of the 18 horses were treated specifically for pericarditis; 10 received antimicrobials and 6 with suspected immune-mediated pericarditis received corticosteroids. Pericardial drainage and lavage were performed on 6 horses in which pericardial effusion or fibrin accumulation was compromising cardiac function. Pericarditis resolved in all 14 horses that were treated, and all 14 returned to their prior Intended use. Clinical Implications With early detection of disease and aggressive treatment, the prognosis for horses with pericarditis is good. (J Am Vet Med Assoc 1998;212:248–253)

Clinical and immunohistochemical characterization of thymic lymphosarcoma in a heifer.

A 2-year-old Holstein heifer with a swollen brisket, jugular vein distention, muffled heart sounds, tachycardia, and free gas bloat was examined. Thymic lymphosarcoma was suspected based on a negative agar gel immunodiffusion test for bovine leukemia virus, presence of atypical lymphocytes in pleural fluid, and detection of a mass in the thoracic inlet. Right-sided cardiac catheterization was performed, and markedly increased jugular venous pressures (41 mm Hg) with a pressure gradient of 29 mm Hg immediately cranial to the heart indicated constriction of the cranial vena cava. Immunohistochemical staining of formalin fixed, paraffin-embedded tissue sections of the tumor using a rabbit antihuman T cell, CD3 polyclonal antibody confirmed that the neoplastic lymphocytes were of thymic origin.

Rupture of the Right Atrium Secondary to Blunt Cardiac Injury

Occult cardiac injury following blunt trauma is underestimated in frequency of occurrence. Recent reports indicate that it rivals thoracic aortic transection as the cause of death following traffic fatalities. The most common mechanisms include rapid cardiac rotation while the great vessels remain fixed, transfer of hydraulic pressure from the abdomen or extremities, and direct myocardial compression by the sternum. Presentation can be diverse and findings can include jugular venous distention, upper extremity cyanosis, unexplained hypotension, and muffled heart sounds. An enlarged cardiac silhouette is occasionally seen on roentgenographic evaluation. A surprisingly large number of these patients are noted to have no significant signs of external thoracic trauma. Possible mechanisms include rapid rotation and deceleration of the heart with fixation of the great vessels, transmission of a large venous pressure wave to the heart following abdominal or extremity compression, and direct compression of the heart by the sternum. Following prompt diagnosis and rapid surgical intervention, a large number of these patients can be expected to survive this otherwise fatal injury.

Bacterial pericarditis in infancy and childhood

The authors report on a cooperative study of 43 cases of bacterial pericarditis observed in children. This disorder was suspected in patients with septicemia who developed symptoms and signs of pericarditis (precordial pain, muffled heart sounds, pericardial friction rub, cardiomegaly). Early diagnosis of this condition is now facilitated by echocardiography. A combination of medical and surgical treatments (appropriate antibiotic therapy after culture and sensitivity tests and early pericardial drainage) led to complete recovery in almost all of the cases (42 of 43). After long-term follow-up, no cases of constrictive pericarditis were observed.

猫の胸腺腫の1例

Thymoma was found in a 10-year-old, female, mongrel cat. She was referred to our hospital with a history of anorexia and acute severe respiratory distress. Physical examination revealed muffled heart sounds and lung sounds were inaudible. Thoracic radiography revealed accumulation of intrathoracic fluid and a mass in the mediastinum that displaced the heart caudally and compressed the cranial lung lobes. About 100 ml of intrathoracic fluid removed by thoracocentesis contained small, mature lymphocytes. After removal of intrathoracic fluid, the general condition improved temporarily. At necropsy, a circumscribed tumor measuring 10×8×5 cm was found in the anterior mediastinum. The mass was soft and contained cystic cavities of various sizes filled with a pale yellowish-red fluid. Histologically, the tumor was characterized by cystic, solid, or cord-like growth of epithelial cells, diffuse infiltration of small, mature lymphocytes and formation of Hassall's body-like structures.

Treatment of Cardiovascular Disease in Cattle

Cardiac diseases of cattle may involve valvular structures, myocardium, pericardium, or blood vessels and are manifested by the clinical signs of cardiac dysrhythmias, cardiac murmurs, generalized edema, muffled heart sounds, jugular venous distention, jugular venous pulsations, pulmonary edema, pleural effusion, or ascites. Digoxin, quinidine, and furosemide can be used effectively to control signs of CHF and cardiac arrhythmias. Combination antimicrobial therapy can be successful for cows with infective endocarditis and thrombophlebitis. Pericardial fluid drainage may temporarily improve cattle with traumatic pericarditis or lymphosarcoma so that short-term goals may be reached.

Traumatic Reticulitis in Cattle: A Review of 60 Fatal Cases

Sixty fatal cases of traumatic reticulitis in cattle were reviewed. Fifty-nine cases were caused by fragments of wire. A nail perforated the reticulum of 1 animal. Common clinical signs included decreased milk production, anorexia, fever, and weight loss. Abnormal or muffled heart sounds associated with pericarditis and epicarditis was the most common sequela, occurring in 40 cases. Fibrous adhesions found at necropsy in all cases suggest that initial clinical signs are difficult to recognize and in most cases it takes weeks to months for abnormalities to be observed.

Successful removal of a heart‐base tumour in a dog with pericardial haemorrhagic effusion

ABSTRACTThis paper describes a case of pericardial haemorrhagic effusion in an eight‐year‐old Labrador Retriever bitch which presented with ascites, muffled heart sounds, a weak femoral pulse and weight loss. The successful removal of a heart‐base tumour is described.

Strut Fracture and Disc Embolization of a Björk-Shiley Mitral Valve Prosthesis: Localization of Embolized Disc by Computerized Axial Tomography

The case of a patient who survived strut fracture and embolization of a Björk-Shiley mitral prosthetic disc is presented. Prompt surgical treatment was directly responsible for survival. In addition, computerized axial tomography of the abdomen aided in localizing and retrieving the embolized disc, which was lodged at the origin of the superior mesenteric artery. A review of similar case reports from the literature supports our conclusions that the development of acute heart failure and absent or muffled prosthetic heart sounds in a patient with a Björk-Shiley prosthetic heart valve inserted prior to 1978 should raise the possibility of valve dysfunction and lead to early reoperation.

Menovazine poisoning

12 / III 1973 between 23 and 24 hours P., 39 years old, in order to terminate pregnancy, drank about 150 ml of "fluid for rubbing joints." She fell asleep shortly thereafter, and on the morning of 13 / III, her mother discovered that she was unconscious. The ambulance doctor stated that the patient was unconscious, the pupils were constricted, and the reaction to light was sluggish. BP 110/60 mm Hg. Art. Muffled heart sounds, pulse 140 beats. in 1 min.