Presence Of Heart Murmur Research Articles

Diagnosis of Neonatal Congenital Heart Disease: A Combination of Heart Murmur, SpO2 Abnormality, Tachypnea, and Extracardiac Malformations

Congenital heart disease (CHD) is one of the commonest congenital malformations that are mostly asymptomatic at birth, which challenges the diagnosis of neonatal CHD. An early accurate prenatal diagnosis will give parents a choice, as well as the opportunity to plan the delivery and improve the postnatal outcome. The purpose of the study is to evaluate the value of heart murmurs, SpO2 abnormalities, tachypnea, and extracardiac malformations in screening neonatal CHD. All 4500 newborns in the obstetrics department of our hospital from January 2019 to January 2020 are selected as study subjects. Newborns were grouped according with the presence of heart murmurs, tachypnea, transdermalSpO2<95%,and extracardiac malformations alone or in combination (≥3). Patients with murmur, tachypnea, and abnormal SpO2 were assigned into group A, those with murmur, tachypnea, and extracardiac malformations into group B, those with murmurs, SpO2, and extracardiac malformations into group C, those with SpO2, tachypnea, and extracardiac malformations into group D, and those with all four into group E. The color echocardiography identified 65 children with CHD (1.4%) among the included 4,500 newborns. When murmur, tachypnea, abnormal SpO2, and extracardiac malformation were independently used to diagnose CHD, the sensitivity ranged from 30.68% to 51.26%, with specificity ranging from 47.36% to 82.65% and Youden’s index (YI) ranging from 0.13 to 0.36. When murmur, tachypnea, abnormal SpO2, extracardiac malformation were together used to diagnose CHD, 91.23% sensitivity, 95.26 specificity, and 0.91 YI were observed. In conclusion, a combination of four indicators, murmur, tachypnea, abnormal SpO2, and extracardiac malformation yielded good performance in diagnosing neonatal CHD.

High-Dose Erythropoietin in Extremely Low Gestational Age Neonates Does Not Alter Risk of Retinopathy of Prematurity

Introduction: The Preterm Erythropoietin (Epo) Neuroprotection (PENUT) Trial sought to determine the safety and efficacy of early high-dose Epo as a potential neuroprotective treatment. We hypothesized that Epo would not increase the incidence or severity of retinopathy of prematurity (ROP). Methods: A total of 941 infants born between 24–0/7 and 27–6/7 weeks’ gestation were randomized to 1,000 U/kg Epo or placebo intravenously for 6 doses, followed by subcutaneous or sham injections of 400 U/kg Epo 3 times a week through 32 weeks post-menstrual age. In this secondary analysis of PENUT trial data, survivors were evaluated for ROP. A modified intention-to-treat approach was used to compare treatment groups. In addition, risk factors for ROP were evaluated using regression methods that account for multiples and allow for adjustment for treatment and gestational age at birth. Results: Of 845 subjects who underwent ROP examination, 503 were diagnosed with ROP with similar incidence and severity between treatment groups. Gestational age at birth, birth weight, prenatal magnesium sulfate, maternal antibiotic exposure, and presence of heart murmur at 2 weeks predicted the development of any ROP, while being on high-frequency oscillator or high-frequency jet ventilation (HFOV/HFJV) at 2 weeks predicted severe ROP. Conclusion: Early high-dose Epo followed by maintenance dosing through 32 weeks does not increase the risk of any or severe ROP in extremely low gestational age neonates. Gestational age, birth weight, maternal treatment with magnesium sulfate, antibiotic use during pregnancy, and presence of a heart murmur at 2 weeks were associated with increased risk of any ROP. Treatment with HFOV/HFJV was associated with an increased risk of severe ROP.

Echocardiographic Evaluation of the Mitral Valve in Cavalier King Charles Spaniels.

Simple SummaryThe incidence of myxomatous mitral valve disease (MMVD) is particularly high in some breeds such as the Cavalier King Charles Spaniel (CKCS) with as many as 90% developing this pathology by the age of 10 years. Our study shows that the American College of Veterinary Internal Medicine (ACVIM) B1 class included extremely different animals. These subjects had significant variability in terms of age (from 6 months to over 11 years), presence and severity of regurgitation and prolapse of mitral valve, as well as presence and intensity of heart murmur. It would therefore seem that in this breed the pathology can essentially follow two different paths: some dogs remain in ACVIM class B1 for a long time (they have a slow progression and persist in class B1 until old age); in others the disease establishes early and progresses rapidly, until it yields symptoms of heart failure even before 8 years. It would therefore be useful to understand whether there are parameters that can early distinguish these two groups.This prospective cross-sectional study aimed to: (1) characterize echocardiographic features of mitral valve in MMVD affected Cavalier King Charles Spaniels (CKCS), focusing on dogs classified as American College of Veterinary Internal Medicine (ACVIM) class B1; (2) compare echocardiographic data in ACVIM B1 dogs divided on the basis of age at time of MMVD diagnosis, in order to understand if different aged subjects had different echocardiographic patterns. Length (AMVL), width (AMVW) and area (AMVA) of the anterior mitral valve leaflet, mitral valve prolapse, diameters of the mitral valve annulus in diastole (MVAd) and systole (MVAs) of 90 CKCS in different ACVIM classes, 64 of which in class B1, were measured. Valvular measurements were indexed to body weight using Wesselowski’s scaling exponents. The presence of heart murmur did not discriminate between A and B1 classes (p = 0.128). Heart enlargement was more frequent in males (r2 = 0.07, p = 0.013). Within class B1, older subjects showed significantly higher values of AMVA, AMVW, MVAd, MVAs and lower sphericity index (SI). Since many CKCS with MMVD have no murmur and their mitral valve has peculiarities, a specifically designed echocardiographic screening should be realized. In addition, different aged B1 dogs have different echocardiographic patterns that may imply different genetic and prognostic profiles.

Successful Surgical Treatment of Idiopathic Chylothorax in a Cat

Background: Chylothorax in cats represents a challenge due to the possibility of involvement of multiple etiologies and the harmful consequences resulting of the presence of the chylous effusion in the thorax. The causes include neoplasms in the thoracic cavity, heart disease and thoracic injuries. It is imperative that clinical nutritional and therapeutic and / or surgical management be immediate and directed to the treatment of the cause. The objective of this work was to report a case of idiopathic chylothorax in a domestic cat solved through surgical intervention and dietary maintenance applied.Case: A 4-year-old male cat, fed with diet for the age range of adult cats, was attended at the Veterinary Hospital of the Federal Rural University of Rio de Janeiro (HV - UFRRJ), with clinical complaint of difficulty breathing, inappetence, prostration and weight loss. In the clinical examination was verified intense tachypnea, presence of heart murmur, normocoratedmucosae, dehydration 7%. The animal was sedated to be submitted to radiographic examination of the thorax with pethidine and midazolam. Thoracic radiographs on the lateral, ventral-dorsal and orthostatic positions were realized and severe pleural effusion was observed in both hemitorax with drainage of 180 mL of lactescent fluid from the right hemithorax and 120 mL of left hemithorax liquid. Through analysis of cavity liquids the effusion was classified as chylous effusion. The hemogram showed a neutrophilic leukocytosis. Serum cholesterol and triglyceride concentrations (28 mg/dL and 43 mg/dL, respectively) were lower than the concentrations of the cavity liquid (67 mg/dL and 722 mg/dL, respectively).Ultrasound examination revealed no mass in the thoracic cavity and no changes in the pulmonary parenchyma. The echocardiographic examination was also performed and did not reveal any cardiac alterations. The initial treatment consisted of the clinical approach, through the exclusive alimentary management with low fat diet, in order to reduce toreduce the amount of chylous in the thorax. The rutine was administered at a dose of 250 mg/cat every 8 h orally. After 15 days, due to an unsatisfactory response to conservative treatment, surgical intervention was indicated. The technique used was pleural omentalization with block ligation of the thoracic duct without mesenteric lymphangiography together with pericardectomy and placement of the thoracic drain. During the postoperative period the animal remained under intensive care, with nasal oxygen therapy and intense analgesia during the first 72 h. After 20 days, the production of the chylous liquid was 2 mL/kg/ day, which made it possible to remove the drain. The cat received continuously with the exclusive diet of low fat to reduce the production of the chylous, without recurrence of chylous up to the present moment.Discussion: It is important to establish in a first approach of animals with chylous exudation the management of low-fat foods, along with appropriate pharmacological therapy, monitoring the patient in a constant and cautious way. If conservative clinical intervention is not satisfactory within 5 to 10 days, rapid surgical treatment is essential, due to the risk offibrosing pleuritis with consequent involvement of the pulmonary parenchyma, as occurred in this report. Duct ligation surgery and the pericardectomy was satisfactory for the resolution of the constant chylous production in the thorax of the animal, as well as the use of the low fat diet was essential to reduce the chylous effusion and fibrosing pleurisy, both the interventions made possible the maintenance of the patient’s health and well-being.Keywords: feline, cavitary fluid, quilting effusion, thoracic duct.

Intrathoracic Axial Osteosarcoma

Background: Bone tumors have a challenging diagnosis and treatment. Osteosarcoma is the name given to a heterogeneous group of malignant, agressive and invasive tumors that often determine bone lysis. Almost all of the animals develop lung metastases, progressing to death. Usually affect the appendicular skeleton, but can also occurs in others areas, although these presentations are rare. Prognosis is always poor. The aim of this paper is to report a case of a dog with osteoblastic osteosarcoma of the sternum, which was diagnosed by computed tomography and histopathologic analysis after excisional biopsy.Case: A male Cocker Spaniel dog, weighing 25 kg, elderly, was examined at the Veterinary Hospital. As main complaint was reported soft swelling on the ventral cervical region causing dyspnea. The patient had previously been medicated with dexamethasone with a significant decrease in the swelling, however recurrence was observed with the cessation of the treatment. Due to the presence of heart murmur, patient underwent to chest radiography and eletrocardiography. Images showed a tumor in the sternal lymph node region, displacing the heart caudally, trachea and esophagus dorsally, causing cranial edema due to a compression of the venous return by the cranial vena cava and subsequent dyspnea. Furosemide (Lasix®) was administered during ambulatorial treatment and prescribed to home, with satisfactory results, with decreased edema and consequent improvement of respiratory symptoms. It was decided to perform computed tomography to better design of the chest structure. The structure located in cranial thoracic region measured about 10.5 cm long x 5.8 cm high x 8.4 cm wide. The patient was undergone to sternotomy to remove the mass that was closely adhered to the sternum and pericardium. The pericardectomy and sternum removal were not performed due to animal being old and present metabolic and cardiopulmonary conditions. Some samples were collected for histological examination resulting in osteoblastic osteosarcoma. After surgical treatment, the patient showed improvement of dyspnea, more active and no signs of pain at the surgical site. Due to the unfavorable result of the histopathological analysis, it was decided to star chemotherapy. The protocol chosen was carboplatin (Carboplatino®) as a single drug, every 21 days totalizing four applications as recommended by literature. Two cycles of carboplatin were done as adjuvant chemotherapy. The patient supported the treatment very well without any clinical or laboratory abnormality. Any radiographic signs of pulmonary metastasis or local recurrence was seen, however, after 18 months of survival, the patient died of non-related cause.Discussion: Osteosarcoma is the most commonly diagnosed bone tumor in dogs. Intense dyspnea and the swelling in the submandibular region was due to the compression of thoracic structures by the size of the tumor and the internal location within the chest. The cranial swelling is due to the syndrome caval that is rare in veterinary medicine and is describe in some specific conditions. Computed tomography was performed to better tumor delineation, as it is an important tool to assess the extent of the tumor and other characteristics, allowing optimal surgical planning for each case. Histophatological diagnosis of osteoblastic osteosarcoma is characterized by new bone formation that appears radiographically with increased radiopacity, as observed in all images. Gold standard treatment of neoplasms is the association of surgical excision followed by chemotherapy, which was effective in this case reported, since it provided quality of life during 18 months, three times higher than the majority of cases reported in the literature, being death due to causes unrelated to the tumor.

HANDOC: A Handy Score to Determine the Need for Echocardiography in Non-β-Hemolytic Streptococcal Bacteremia.

Non-β-hemolytic streptococci (NBHS) can cause infective endocarditis (IE). Echocardiography is used to diagnose IE, but it is not known which patients with NBHS bacteremia should undergo echocardiography. Medical records of patients with NBHS bacteremia in southern Sweden from 2012 to 2014 were studied retrospectively. The patients were divided into 2 cohorts. In the first, correlations between the reported data and IE were studied. These variables were used to construct the HANDOC score, which was then validated in the second cohort. Three hundred thirty-nine patients with NBHS bacteremia were included in the first cohort, of whom 26 fulfilled the criteria for IE. Several factors differed significantly between the patients with IE and those without. Among these variables, the presence of Heart murmur or valve disease; Aetiology with the groups of Streptococcus mutans, Streptococcus bovis, Streptococcus sanguinis, or Streptococcus anginosus; Number of positive blood cultures ≥2; Duration of symptoms of 7 days or more; Only 1 species growing in blood cultures; and Community-acquired infection were chosen to form the HANDOC score. With a cutoff between 2 and 3 points, HANDOC had a sensitivity of 100% and specificity of 73% in the first cohort. When tested in the validation cohort (n = 399), the sensitivity was 100% and the specificity 76%. HANDOC can be used in to identify patients with NBHS bacteremia who have a risk of IE so low that echocardiography can be omitted; therefore, its implementation might reduce the use of echocardiography.

Prevalence of Heart Disease of Elementary Schoolchildren in a Well-To-Do Population Group, Jakarta 1973

This study, using as the screening method the presence of heart murmurs, yielded only 28 suspected cases of heart disease. Eight out of the 28 cases were definitely heart disease cases. Two with acquired heart disease (mitral insufficiency) and six with congenital heart disease (4 ventricular septal defect, one atrial septal defect, one patent ductus arteriosus). Growth retardation was observed in 7 children regarding their heights and weights which were less than the lower limit for the normal heights and weights for schoolchildren in Jakarta.

Cardiac Morphology and Heart Murmurs in Elite Eventing and Dressage Horses

IntroductionTraining related cardiac adaptation is documented in Standardbreds and Thoroughbreds, including an increased incidence of AV valve regurgitation. In Warmbloods less is known about training effects on cardiac function or subclinical valve regurgitation.MethodsFifteen adult untrained Warmbloods (aged 3.8 ± 0.7 years) were compared with fifteen adult Warmblood eventers (aged 11.4 ± 0.9 years) competing at CIC2* (group 1, n = 5) and CCI2*, CIC3*, CCI3* and CCI4*levels (group 2, n = 9) and fifteen healthy adult Warmbloods competing at advanced dressage (group 3, n = 5), Prix Saint Georges, Intermediate or Grand Prix (group 4, n = 10) levels (mean age 10.3 ± 0.7 years). The presence of heart murmurs, valve regurgitation and echocardiographic parameters were evaluated, and training intensity was scored. A correlation was found between bodyweight and not height. Differences in cardiac morphology were compared using General Linear Models with post‐hoc Bonferroni correction (SPSS version 20), using group and bodyweight as covariates. Significance was set at P<0.05.Prevalence of audible heart murmurs and valvular regurgitation was higher in eventers (0–20% and 29–79%, respectively and dressage horses (7–40% and 7–60%, respectively) than controls (0–20% and 7–20%, respectively). Interventricular septum in diastole (IVSd, left ventricular mass (LVM) and LV mean wall thickness (LVMWT) were greater in groups 2 and 4 than controls; group 4 also had a greater pulmonary artery diameter (PAD) and LV posterior wall (LVPWd). Group 1 showed a greater LVMWT; group 4 a greater end point septal separation (EPSS). Training intensity influenced in both categories IVSd and MWT; in eventers also the right ventricular diameter in diastole and in dressage horses also LVPWd, LVM, EPSS and PAD.Elite eventers and dressage horses showed an increased prevalence of audible murmurs and valvular regurgitation. Cardiac adaptations resembled those associated with resistance and endurance training. Increased performance level and training intensity accompanied increased cardiac muscle thickness and volume. These effects should be considered during sales and performance evaluations.Ethical Animal ResearchEvaluated by the Animal Ethics Committee of Utrecht University and owner consent was obtained. Sources of funding: Faculty of Veterinary Medicine, Utrecht University. Competing interests: none.

1143 Predictors of Duct Dependent Congenital Heart Disease in Infants Transferred by Newborn Emergency Transport Service (NETS) Victoria

BackgroundDuct dependent congenital heart disease (DDCHD) may be difficult to distinguish from other diagnoses, notably persistent pulmonary hypertension (PPHN). Affected infants born in regional hospitals require transfer to a tertiary...

Aetiology and outcome in 90 cats presenting with dyspnoea in a referral population

Objectives: Dyspnoea is an unspecific severe presenting sign, which can be life threatening and requires prompt treatment. Dyspnoeic cats often have significant underlying disease. Underlying aetiologies in cats that presented with dyspnoea were reviewed, and associations with patient signalment and outcome were investigated. Methods: The case records of 90 dyspnoeic cats were retrospectively reviewed and separated into different groups depending on aetiology (cardiac, respiratory, neoplastic and trauma). Duration of clinical signs, presentation, hospitalisation length and survival were analysed. Results: Cardiac (38 per cent), respiratory (32 per cent) and neoplastic (20 per cent) diseases were common causes of feline dyspnoea. Cats with respiratory causes had longer duration of clinical signs (P<0·001) before presentation. Cats with neoplasia were significantly older (P<0·001). No significant difference in respiratory rates was present between the groups (P = 0·154). High heart rates (P<0·001) and abnormalities on cardiac auscultation were more likely in the cardiac group. Clinical Significance: Frequent causes of dyspnoea in cats were cardiac disease followed by respiratory causes and neoplastic conditions. Heart rate on presentation and presence of heart murmurs or gallops are useful to identify cardiac causes. Improved proportion surviving was found in the respiratory group (P = 0·027), whereas cats with neoplasia had the worst outcome.

Human babesiosis in New York State: Review of 139 hospitalized cases and analysis of prognostic factors.

Babesiosis infections are infrequent, occur in limited geographic locations, and range from asymptomatic infection to severe illness and death. Descriptive clinical and epidemiological information on human babesiosis cases was collated from state communicable disease reports and medical records of patients hospitalized from 1982 to 1993. Univariate and multivariate analyses were performed to determine prognostic factors associated with severe disease outcome (hospitalization ending in death, duration of hospitalization > 14 days, or intensive care unit stay > 2 days). Between 1982 and 1993, 139 patients were hospitalized with babesiosis in New York State. Nine patients (6.5%) died, 35 (25.2%) were admitted to the intensive care unit, and 35 (25.2%) required hospitalization for more than 14 days. Mean age at first hospitalization was 62.5 years. Sixty-two percent were male, and 91% resided in Suffolk County, Long Island. The most common symptoms were fatigue/malaise/weakness (91%), fever (91%), shaking chills (77%), and diaphoresis (69%). Past medical records showed that 52% of patients had a history of chronic disease; 12% had a history of Lyme disease; 12% had undergone a splenectomy; and 2% had undergone a blood transfusion. There was a 12- to 14-day delay between onset of symptoms and initiation of appropriate antibiotic treatment. Univariate analyses showed alkaline phosphatase levels greater than 125 U/L, white blood cell counts greater than 5 x 10(9)/L, history of cardiac abnormality, history of splenectomy, presence of heart murmur, and parasitemia values of 0.04 or higher to be significantly associated with disease severity. Multiple logistic regression analyses indicated that male sex, alkaline phosphatase values greater than 125 U/L, and white blood cell counts greater than 5 x 10(9)/L remained strong predictors of severe outcome. Human babesiosis is a rare but debilitating and potentially fatal illness, especially in the elderly. Prompt disease diagnosis and treatment are essential but are often delayed, as seen in our series. This delay reinforces the need for enhanced public and physician education targeted toward residents and visitors to the few high-risk geographic areas where disease and Ixodes scapularis ticks are endemic. Patients presenting with certain prognostic indicators (male sex, alkaline phosphatase values > 125 U/L, and white blood cell counts >5 x 10(9)/L) require comprehensive and aggressive medical care to prevent further deterioration. Since babesiosis is only 1 of 3 currently recognized diseases transmitted by I scapularis ticks, primary prevention recommendations will also reduce human exposure to Lyme disease and human granulocytic ehrlichiosis.

Indication of Echocardiographic Investigation in the Neonatal period: Value of Risk Groups. 1028

We studied the prevalence of congenital heart diseases (CHD) in newborns from risk groups in order to verify whether such risks justify the routine utilization of echocardiographic examination. We also wanted to evaluate the frequency of the different types of CHD; the positive and negative predictive values for CHD in the presence of heart murmurs, as well as the association between CHD and sex, race, birth weight, gestational age, post natal age and presence of cardiac signs.

Management of bacterial endocarditis-1970

Bacterial endocarditis continues to be an important and challenging problem. Diagnosis depends upon consideration of this entity in patients with unexplained fever with or without the presence of heart murmurs and evidence of embolic lesions. Five blood cultures will document the presence of a more or less continuous bacteremia. Treatment depends upon selection of the appropriate antibiotic by disc or tube dilution sensitivity studies, or both. Optimal dosage can be documented by serum bactericidal levels. Duration of treatment on an empirical basis is outlined. Special problems including penicillin allergy, culture-negative endocarditis and endocarditis caused by fungi and gram-negative bacilli are discussed. The role of surgery in acute bacterial endocarditis is reviewed. Endocarditis affecting prosthetic valves is discussed along with current recommendations for prevention and treatment of this increasing problem. The role of antibiotic prophylaxis is discussed.