Presence Of Murmur Research Articles

Interpretation of Heart and Lungs Sounds Acquired via Remote, Digital Auscultation Reached Fair-to-Substantial Levels of Consensus among Specialist Physicians.

Technological advancement may bridge gaps between long-practiced medical competencies and modern technologies. Such a domain is the application of digital stethoscopes used for physical examination in telemedicine. This study aimed to validate the level of consensus among physicians regarding the interpretation of remote, digital auscultation of heart and lung sounds. Seven specialist physicians considered both the technical quality and clinical interpretation of auscultation findings of pre-recorded heart and lung sounds of patients hospitalized in their homes. TytoCareTM system was used as a remote, digital stethoscope. In total, 140 sounds (70 heart and 70 lungs) were presented to seven specialists. The level of agreement was measured using Fleiss' Kappa (FK) variable. Agreement relating to heart sounds reached low-to-moderate consensus: the overall technical quality (FK = 0.199), rhythm regularity (FK = 0.328), presence of murmurs (FK = 0.469), appreciation of sounds as remote (FK = 0.011), and an overall diagnosis as normal or pathologic (FK = 0.304). The interpretation of some of the lung sounds reached a higher consensus: the overall technical quality (FK = 0.169), crepitus (FK = 0.514), wheezing (FK = 0.704), bronchial sounds (FK = 0.034), and an overall diagnosis as normal or pathological (FK = 0.386). Most Fleiss' Kappa values were in the range of "fare consensus", while in the domains of diagnosing lung crepitus and wheezing, the values increased to the "substantial" level. Bio signals, as recorded auscultations of the heart and lung sounds serving the process of clinical assessment of remotely situated patients, do not achieve a high enough level of agreement between specialized physicians. These findings should serve as a catalyzer for improving the process of telemedicine-attained bio-signals and their clinical interpretation.

Information Provided by Breeders and Referring Veterinarians about the Presence and Meaning of a Murmur to Owners of Newly Purchased Puppies with a Later Confirmed Congenital Heart Disease.

Background: A recent study revealed that only 10% of puppies diagnosed with a congenital heart disease were referred for murmur investigation to a veterinary cardiology specialist while the puppies were in the breeders' possession. Whether the new owners had been informed about the presence of a murmur before purchasing a puppy was not investigated. Methods: New owners whose dogs were diagnosed with a congenital heart disease at the authors' institution in a 1-year period received a questionnaire during the consult after cardiac auscultation but before performing an echocardiogram. The main study aims were to reveal whether the breeders had informed the new owners about the presence of a murmur before purchasing the puppy, and whether the owners would have still chosen to buy that specific puppy if they had known about a potentially present congenital heart disease. Results: Of the 60 interviewed owners, 72% would have refrained from buying the puppy if they had known about the presence of a congenital heart disease. However, only 23% of them were informed about the presence of a cardiac murmur before purchase. Conclusions: Most owners would have chosen to buy a healthy puppy without a heart disease if they had been informed.

Pattern of Congenital Heart Diseases among Term and Preterm Neonates in a Tertiary Care Hospital of a Developing Country

Objective: To determine the frequency and pattern of various congenital heart diseases in a tertiary care hospital neonatal unit.
 Study Design: Prospective longitudinal study.
 Place and Duration of Study: Neonatal Unit of Pak Emirates Military Hospital, Rawalpindi Pakistan from Jul 2015 to Jun 2018.
 Methodology: All neonates admitted to the Neonatal Unit of Pak Emirates Military Hospital, Rawalpindi Pakistan, suspected of having congenital heart disease were included in the study. Suspicion for CHD was based on the presence of murmur, cyanosis with or without feeding difficulty, signs of congestive heart failure, and variation in pre and post-ductal SpO2 reading. Echocardiography was performed on all neonates by a Paediatric cardiologist to determine diagnosis and type of lesion.
 Results: One hundred and thirty-one neonates were found to have congenital heart disease with male predominance, with 79(60.3%) males and 52(39.7%) females. Ventricular Septal Defect (VSD) was the most common lesion occurring in 44(33.6%) neonates, followed by PDA in 28(21.37%) neonates. CHD occurred more frequently in term neonates (62.0%) than preterm neonates (38.0%).
 Conclusion: Congenital heart disease is the most common congenital malformation, with Asia having the highest prevalence worldwide. Lack of specialized antenatal and neonatal health services and paucity of diagnostic facilities lead to delays in diagnosis, increasing morbidity and mortality of CHD cases. Therefore, drastic measures are required to improve neonatal health and transport facilities in our country to mitigate the impact of this disease.

Abstract 14001: Using the S2 Sound as an Early Marker of Aortic Valve Calcification

Introduction: Heart valve diseases (HVDs) often remain undiagnosed until late stages, especially in underserved populations, leading to significant comorbidities. Artificial intelligence has improved murmur detection in digital phonocardiograms (PCG). However, the presence of murmurs depends on hemodynamic factors unrelated to HVD. Screening tests that directly measure features of valvular remodeling regardless of symptoms would improve HVD diagnosis. We used a mouse model of chronic kidney disease (CKD) induced aortic valve (AoV) remodeling to determine whether S2 sound changes can be used to detect early stages of AoV calcification. Methods: Eight-week old C57BL/6J mice (n=24) were assigned the following diets for 12 weeks: 1) control group fed a normal chow diet, 2) CKD group fed an adenine-supplemented diet to induce CKD, and 3) CKD+HP group fed the CKD diet for 6 weeks, then an adenine and high phosphate (HP)-supplemented diet for another 6 weeks to induce AoV calcification. PCG signals were recorded every 6 weeks. Endpoint AoV calcification and echocardiogram measures of valvular function were assessed. We developed a clustering method based on time domain principal component analysis of S2 sounds collected at week 6 (W6) to classify week 12 (W12) S2 sounds and identify S2 sound alterations due to HP. Results: The high phosphate diet induced AoV calcification in CKD+HP mice (1a). Of the total number of S2 sounds per mouse, an average of 84.18% and 81.15% S2 sounds (1b and 1c) were accurately classified as control or CKD mice with a specificity and sensitivity of 90.91% and 100%, respectively. CKD+HP mice had an average of 59.22% W12 S2 sounds that neither classified as control nor CKD. Conclusions: Mice that have AoV calcification show distinct S2 sounds features that were absent in the control and CKD groups. In this study, we demonstrate the feasibility of using the S2 sound not only to detect AoV calcification prior to expected hemodynamic changes but also to detect CKD.

Pattern of Congenital Heart Diseases in Children with Congenital Malformations: An Echocardiographic study from a Tertiary Health facility in Sokoto, Nigeria

Background: Children with congenital malformations (CM) may have congenital heart diseases (CHDs) which may be initially asymptomatic. These need to be recognised and managed early in order to reduce unnecessary morbidity in affected patients. We report the pattern of CHDs in children with congenital malformations who had echocardiography over a one year period in UDUTH, Sokoto. Materials and Methods: A cross-sectional study carried out in the Paediatric Cardiology Unit from 1st January to 31st December 2019. Children presenting with CM were recruited and had echocardiagraphic screening for CHDs. Data were analysed with SPSS 23 version. Statistical significance was taken at p < 0.05. Results: 81 children were seen with CM, comprising 42 females and 39 males (M:F=0.93:1); age range of 2 days to 13 years. Most frequent malformationswere anorectal malformations (ARM) in 28 (34.6%), Down syndrome in 17 (21.0%), multiple CM 10 (8.1%) and ocular abnormalities in 4 (4.9%). Thirty two (39.5%) of the patients with CM were diagnosed with CHD, out of which 24 (29.6%) had cardiac murmur. Most frequent CHD was atrioventricular septal defect in 9 (28.1%) followed by ventricular septal defect in 8 (25.0%) and patent arterial duct in 4 (12.5%). CHDs were found in all (100%) those with ocular abnormalities, in 76.5% of Down syndrome and in 14.3% of patients with ARM. Presence of murmur was significantly associated with CHD (χ2=18.0; p=0.001; OR=8.2; 95% C.1=2.8 – 24.1). Conclusion: Congenital malformations, particularly Down syndrome and ocular abnormalities, are significantly associated with CHDs. Cardiac murmurs were suggestive of CHD in children with congenital malformations.

Detection of Murmur from Non-Stationarity of Heart Sounds

Early diagnosis of heart diseases bears a major role in saving lives. Presence of spurious extra-frequency components, termed as murmurs within the phonocardiography record may be indicative of valvular disorders like stenosis, lesions or regurgitation. It is difficult to identify the subtitle spectral components of murmurs through subjective audition. In this paper, a technique is proposed to detect the presence of murmur from the heart signal by analyzing their non-stationarity behavior by using autocorrelation based features namely, Standard Error (SE) of Auto-Correlation Function (ACF) and absolute deviation of SE from the reciprocal of the square root of number of samples (β). The selected features corresponding to normal and murmur differ with a ‘P’ value of 1.80 x10-14 (dataset 1) and 2.20 x10-76 (dataset 2) for SE and β, respectively. It is found that SE and β could effectively distinguish normal and murmur with 100% accuracy, sensitivity, and specificity.

ST-Elevation Myocardial Infarction Associated With Infective Endocarditis

ST-elevation myocardial infarction (STEMI) as a complication of infective endocarditis (IE) is a rarely reported entity. No clear guidelines exist with regards to the management of this medical emergency. We sought to systematically review the clinical presentation and management of this condition. We searched relevant articles on STEMI associated with IE and extracted data on demographic variables, key clinical characteristics upon presentation, treatment strategies, and clinical outcomes. We identified 100 patients from 95 articles. The mean age at presentation was 53 ± 17 years with male preponderance (n = 63, 63%, p = 0.01). Most patients (63 of 100, 63%) presented with STEMI as their first manifestation of IE, with others occurring at 15 ± 17 days after diagnosis of IE. Findings that suggested possible septic emboli were not consistently present, including history of prosthetic valve placement (15%), presence of other embolic disease (27%), fever (42%) increased leukocyte count (80%), and presence of murmur (88%). Atherosclerotic disease was absent in 95% on cardiac catheterization. Eleven patients receiving tissue plasminogen activator fared poorly, with 9 major bleeds; balloon angioplasty was successful in 56% (9 of 16 cases), aspiration thombectomy in 68% (21 of 31 cases), and coronary stenting in 81% (14 of 16 cases). The 30-day mortality was 43%. In conclusion, patients with STEMI in the face of recent IE, new precordial murmur, fever, increased leukocyte count or other embolic events, septic emboli should be considered as a cause for STEMI. Best practices for management are not known, but thrombolytics appear to carry significant bleeding and embolic risks.

Clinical suspicion of congenital heart diseases during well-baby follow-up and echocardiographic correlation

Background: Congenital heart disease (CHD), the most common cardiac malformation in the fetal and neonatal period, represents a heterogeneous group of defects with little known cause. Despite advances in detection and treatment, CHD accounts for 3% of all infant deaths and 46% of death from congenital malformations. CHD patients with minimum or no symptoms are frequently under diagnosed in areas with inadequate health services. The aim of this study was to investigate the role of clinical suspicion of congenital heart disease in babies who presented for well-baby follow-up against echocardiographic findings and to study the clinical spectrum of all the CHD that were diagnosed. Methods: The study involved analysis of data collected by the authors while working in a tertiary care center at Mumbai, India, during 2009 to 2010. All the babies born from April 2009 to August 2010 (17 months) and those who came for well-baby visits (with or without symptoms) were examined carefully for findings on cardiac examination including abnormalities of heart sound and presence of murmur on auscultation. Findings of the echocardiography were recorded for follow up and all the babies were followed up on at least three-monthly basis. Echocardiography was repeated on a quarterly basis in symptomatic babies and six-monthly basis in asymptomatic babies with small septal defects. All the babies on follow up were closely monitored clinically and on echocardiography for ascertaining the natural course of the observed defects. Results: A total of 1856 babies were born at the tertiary care center out of which 1688 were seen at the well-baby clinic. A total of 42 cases were referred for echocardiography on clinical suspicion of CHD and out of these 21 (50%) were positive for some form of CHD. Most common CHD diagnosed was atrial septal defect (ASD). There was no spontaneous closure of ventricular septal defects (VSD), though, 02 cases of ASD less than 3 mm closed during the during the follow up period.Conclusions: This study demonstrated that clinical experience is a valuable tool in early diagnosis of CHD, even if they are asymptomatic. Early echocardiography is justified to diagnose the cases so that appropriate follow-up and management decisions could be planned. Though majority of the cases were moderate to small ASD and VSD, there is a need to diagnose them early and follow them up till closure.

Prenatal identification of CHD murmur using four segment phonocardiographic signal analysis

Congenital heart defects (CHD) are one of the utmost birth defects present in the neonatal after birth and a big challenge for the researchers to identify the structural abnormality during the antepartum period. An algorithm is presented here to identify the presence of CHD through foetal phonocardiographic (fPCG) signals. The recorded fPCG is decomposed using Daubechies4 wavelet with sub-level threshold to remove the noise in the signal. The Shannon energy is used to identify the different peaks of signals and then S1 and S2 according to the intervals between adjacent peaks. The signal is segmented into four important parts: S1, S1S2, S2 and S2S1. The FFT is used to identify the frequency component present in four segments which in turn indicates the presence of pathological murmur that may turn into CHD. The algorithm is tested on 25 samples with accuracy rate 88% in identifying the presence of a murmur.

To evaluate the prevalence of symptomatic and non-symptomatic ductus arteriosus and accuracy of physical signs in diagnosing PDA in preterm infants using blinded comparison of clinical and echocardiographic findings during the first week of life: a prospective observational study from Iran

Aims: To evaluate the prevalence of symptomatic and non-symptomatic ductus arteriosus (PDA) and accuracy of physical signs in diagnosing PDA in preterm infants using blinded comparison of clinical and echocardiographic findings during the first week of life.Methods and material: This prospective observational cross-sectional study enrolled 200 preterm infants, who underwent echocardiography on 4th–7th postnatal day. The neonates who were diagnosed to have PDA on echo were observed for clinical features of PDA to label it symptomatic PDA. Symptomatic PDA was defined as detecting one or all of these symptoms in a neonate with PDA: bounding pulse, pericardial hyperactivity, systolic or continuous murmur.Results: Forty-five infants had PDA on echocardiography. 66.7% neonates with PDA were symptomatic and the most prevalent symptom in them was heart murmur (100%) either alone or combined with other clinical features. Isolated murmur was seen in 31.2%, murmur and hyperdynamic precordium was seen in 8.8%, murmur and bounding pulses were seen in 6.67% and all three features simultaneously were seen in 20% of infants. The sensitivity of murmur for diagnosing symptomatic PDA was highest.Conclusion: Presence of murmur is the most important clinical feature for diagnosis of symptomatic PDA and has good specificity.

Optimized Wireless Stethoscope Using Butterworth Filter

Acoustic stethoscope is a primary diagnostic tool used by doctors for effective analysis of various diseases. But, it suffers defects such as low level heart sounds and presence of murmurs. This project aims at developing ‘Noise removal in stethoscope using Butterworth filter’. In this, the low level heart sounds were amplified with high gain pre-amplifier circuit. A review of basic filters like low pass RC filter, Butterworth filter, Chebyshev filter and Bessel filter are done for elimination of murmurs and best suited filter is suggested. Finally, amplified noise free heart sounds are simulated using Proteus 7.4. The results prove that efficient filter for designing is ‘Butterworth filter’.

PO-0033 Referrals For Echocardiograms In A District General Hospital – Are We On The Pulse?

<h3>Background and aims</h3> Echocardiograms are a major resource for diagnosing congenital and acquired heart disease. Paediatricians with special expertise in Paediatric Cardiology are now at the forefront of the paediatric cardiac care service. The aim of this audit was to report on the quality of referrals – investigating the indications for referral, documentation of symptoms and signs. <h3>Methods</h3> The medical notes of 46 children who attended outpatient echocardiogram clinic were retrospectively reviewed (April to June 2012). We looked at indications for referral, documentation of symptoms and signs in the initial referral letters. <h3>Results</h3> 41 out of 46 children attended the clinics, of which 39 sets of notes were available to be reviewed. 22 were new and 17 were follow-ups. The main indications for referral were presence of murmur, family history, congenital heart disease, syndromes and Kawasaki Disease. 16 children were referred because of murmur, 12 of whom were asymptomatic. Half did not comment on grade, position or radiation of the murmur. One-third did not have documentation of femoral pulses, signs of heart failure (crackles on auscultation, hepatomegaly, oedema). <h3>Conclusions</h3> Indications for referral to echocardiogram clinic were appropriate. However, the quality of documentation of basic examination findings was poor. This audit starts a discussion regarding setting the standard for quality of referrals to echocardiogram clinic, and highlights deficiencies in documentation. Recommendations include a standardised pro forma and an emphasis during general practice study days.

PO-0507 Patent Ductus Arteriosus (pda) In Preterm Infants: Correlating Clinical And Echocardiographic Findings

Objectives To investigate and correlate clinical signs of PDA with echocardiographic findings beyond day 5 of life in preterm infants. Methods Infants ≤33 weeks of gestation and ≤2.0 kg were included in this prospective observational study. The patients with acute illness (eg Sepsis, NEC) and with congenital heart defect were excluded. Demographic (gestational age, birth weight, gender and Apgar scores), clinical (presence of murmur, blood pressure and pulse pressure) and echocardiographic parameters (presence of PDA, PDA size, flow velocity and LA/Ao) were collected. Results 29 neonates met the study criteria and 61 echocardiograms were performed. All except one (VSD) had a structurally normal heart on echocardiogram and the remainder had a PDA alone. 19/28 had both a murmur and PDA while 9 patients had a PDA without a murmur. The mean PDA size in neonates with a clinical murmur was greater than those with no clinical murmur (0.25 vs. 0.16 cm; p 1.2 in 18/28 patients and only 5 had wide pulse pressure. Conclusion Clinical findings alone cannot diagnose a PDA in preterm infants and echocardiogram is required to exclude abnormal anatomy and confirm the presence of a PDA. The pulse pressure is more relevant within first 7 to 10 days of life.

Echocardiography Is Dispensable in Uncomplicated Staphylococcus aureus Bacteremia

Current Staphylococcus aureus bacteremia (SAB) practice guidelines stratify treatment duration according to the likelihood of complications and recommend transesophageal echocardiography (TEE) in all cases. The benefit of TEE in uncomplicated SAB has not been validated. We performed a retrospective analysis of TEE and transthoracic echocardiography (TTE) among hospitalized adults with SAB in 3 prior observational studies (2002–2003, 2005–2006, and 2008–2009). Echocardiograms were ordered at the attending physician’s discretion. SAB cases were stratified into the following types: complicated (persistent bacteremia [duration ≥3 d], relapse, and/or secondary foci); device-associated (intracardiac prosthetic devices); suspected endocarditis (the presence of murmurs or emboli); and uncomplicated (bacteremia duration ≤2 d, no device and/or secondary foci). We encountered 960 SAB cases; 83 were excluded (57 death/transfer/discharge within 48 h; 19 contaminants/no treatment; 7 care withdrawn). TEE and TTE were performed within 0–28 days of SAB onset in 177 (20.2%) and 321 (36.6%) instances, respectively. TEE was positive (with signs of endocarditis) in 42/177 (23.7%) cases: 7/39 (17.9%) community associated and 35/138 (25.4%) health care associated. It was positive in 29/120 (24.2%) complicated, 3/11 (27.3%) device-associated, 9/15 (60.0%) suspected endocarditis, and 1/31 (3.2%) uncomplicated cases of SAB. TTE was positive in 25/321 (7.8%) cases of SAB, 1 was uncomplicated; it was negative in 20/30 (66.7%) TEE-positive cases. Follow-up of ≥100 days was possible in 282/361 (78.1%) uncomplicated SAB; many (46.8%) received ≤15 days of therapy. None of them had relapses or secondary foci.These findings suggest that echocardiography is dispensable in cases of uncomplicated community-associated and health care-associated SAB. It should be limited to subsets with clinical findings of endocarditis, persistence, intracardiac devices, secondary foci, and relapse. The cost effectiveness of TTE prior to TEE among these patients is unknown.

Arteritis de Takayasu en pediatría

Takayasu's arteritis is a chronic inflammatory disease that primarily affects the large vessels, such as the aorta and its branches. It represents the third most frequent vasculitis during pediatric age. Our objective was to describe clinical and complementary exams features as well as treatment modalities of a case series of pediatric patients. We present 11 patients (10 girls) with median age at onset of 8 years (range: 2-15). The median diagnosis delay was 16 months (range: 2-96). Clinical presentations were lower limb claudication, arterial hypertension, CNS involvement, presence of murmurs, systemic symptoms, lymphadenopathy, chest pain, abdominal pain and arthritis. Laboratory tests showed: elevated ESR, anemia and trombocytosis. Vascular imaging studies exhibited stenosis, dilatation, occlussion and aneurysms. The outcome of the disease was persistent active condition (1 patient), relapse (4 patients), remission (3 patients), motor sequelae (1 patient) and death (2 patients). All patients were treated with steroids and immunosuppressants. Takayasu 's arteritis is a condition that can potentially be life-threatening. The diagnosis should be suspected in a variety of clinical manifestations during childhood.

Dissecção aguda de aorta como apresentação de emergência hipertensiva

, 2008 CASE REPORT A 53-year-old Caucasian male patient from Olimpia, Sao Paulo, with arterial hypertension for 16 years without treatment. He was admitted to the emergency room in October 2006 with sudden, high-intensity chest pain for about 3 hours that had spread to the abdomen and left inferior limb, with hyperhidrosis, palpitations and severe blood pressure elevation. The patient was an alcoholic - 1 bottle of beer per day for 20 years. He denied smoking, diabetes, dyslipidemia and any other previous cardiovascular events. The patient was in good general condition, hydrated, ruddy, cyanotic (2+/4+), eupneic, afebrile, in and out of consciousness. Respiratory auscultation was normal. Cardiac auscultation was rhythmic and normal and without the presence of murmurs. Arterial blood pressure (ABP) was 170 x 110mmHg and heart rate was 86 bpm. The left inferior limb was cyanotic and with a slight loss of sensation. Pulses were not palpable in the femoral and dorsal artery of the left foot. He was monitored and treated with sodium nitroprusside and intravenous metopolol. Upon admission, the patient presented creatine phosphokinase (CPK) 12.589 IU/l, glutamic oxalacetic transaminase (AST) 440U/l, glutamic- pyruvic transaminase (GPT) 148U/L, lactic acid 4.3 mmol/l, ultrasensitive PCR 8.33mg/dl. His glycemia was 133mg/dL and his creatinine level was at 1.4mg/dl. Hemogram showed neutrophils with fine toxic granulations, leukocytosis, relative and absolute neutrophilia and relative leukopenia. Chest radiography and electrocardiogram was normal. Magnetic resonance angiography diagnosed Stanford type B aortic dissection, with hypoperfusion of the anterior portion of the left kidney. Aortography image showed image of double lumen in descending thoracic aorta (Figure 1), successfully treated with Braile Biomedica self-expandable prosthesis (stent) of 34mm in diameter and 90 mm in length (Figure 2).

Cardiac troponin I is elevated in dogs and cats with azotaemia renal failure and in dogs with non‐cardiac systemic disease

To determine if dogs and cats with renal failure, or other severe non-cardiac disease, and no antemortem evidence of cardiac disease on basic clinical evaluation, have elevated levels of cardiac troponin I (cTnI). Cross-sectional study using 56 dogs and 14 cats with primary non-cardiac disease (39 dogs with azotaemic renal failure, 14 cats with azotaemic renal failure, 17 dogs with non-cardiac systemic disease); 7/25 dogs and 6/14 cats had murmurs detected on physical examination. Serum or heparinised plasma was collected and analysed for cTnI. Cardiac troponin I concentrations were elevated above reference intervals in 70% of dogs and 70% of cats with azotaemic renal failure and in 70% of dogs with a variety of systemic non-cardiac diseases. Cardiac troponin I concentrations did not correlate with the degree of azotaemia, presence of murmurs, hypertension or type of non-cardiac illness. Cardiac troponin I concentration is often elevated in dogs and cats with azotaemic renal failure and in dogs with other systemic non-cardiac illness, suggesting that these conditions often result in clinically inapparent myocardial injury or possibly altered elimination of cTnI.

Cardiology patient pages. Innocent murmurs: a parent's guide.

Murmurs are sounds or noises made by blood as it flows through the heart and blood vessels of the body. Murmurs can be caused by abnormal flow patterns that occur when there are abnormalities of the heart valves, holes within the heart, or abnormal communications between blood vessels or between blood vessels and the heart. In infants and children, most murmurs originate through normal flow patterns, however, and are referred to as innocent, physiological, or normal murmurs. By innocent , we mean that there are no structural (anatomic) or functional (physiological) abnormalities of the heart and that the murmur comes from normal flow within a normal heart. Innocent is the preferred term because it strongly conveys that nothing is wrong, as opposed to the older term functional , which is not always clearly understood as being normal by parents and patients. Although murmurs termed innocent may be heard in virtually anyone, they are most often heard in childhood. Although innocent murmurs may be prevalent mostly in childhood, the presence of murmur does not imply the presence of structural heart disease. Congenital heart defects, which are responsible for most of the heart problems in children in the developed world, are structural abnormalities caused by errors in the development of the heart while the child is still in the womb. The heart starts out as a single tube and, during the first eight …

The development of the perception of cues to the [m]-[n] distinction in CV syllables.

The contribution of the nasal murmur and vocalic formant transition to the perception of the [m]-[n] distinction by adult listeners was investigated for speakers of different ages. Children, aged 3, 5, and 7, and an adult female and male produced consonant-vowel (CV) syllables consisting of either [m] or [n] and followed by [i ae u a]. Three productions of each syllable were computer edited into the following segments: (1) full murmur; (2) 50-ms murmur preceding release; (3) 25-ms murmur preceding release; (4) 25-ms murmur preceding release +25-ms transition following release; (5) 25-ms transition following release; (6) 50-ms transition following release; and (7) full transition+vowel. The results indicate that both the murmur and transition provide cues to place of articulation, but that the latter property is more prominent in perception than the former across speaker age. The salience of the murmur and vocalic transition cues was greater for adults than children indicating a developmental progression of the encoding of gestures associated with these properties. Although the simultaneous presence of murmur and vocalic transition cues surrounding the point of spectral discontinuity improved perception of place of articulation across speakers, there was evidence of a developmental progression of this property also. For speakers of all ages, as segment duration decreased, consistent decrements in identification of place of articulation occurred only for transition stimuli. The murmur+transition was the most salient cue supporting the importance of spectral discontinuities and/or relational properties in production and perception particularly in the acquisition of sound features.

Predictability of mitral regurgitation detected by Doppler echocardiography in patients referred for cardiac transplantation

Mitral regurgitation (MR) is common in patients with congestive heart failure (CHF), but the frequency in relation to the origin of ventricular dilatation has not been established. In 50 patients referred for cardiac transplantation, MR was assessed by Doppler echocardiography and the findings were compared with clinical information. Dilatation of the left ventricle, left atrium and mitral anulus was analyzed in 25 patients with respect to cause of CHF. All 50 patients had MR of at least moderate severity, regardless of cause (idiopathic dilated cardiomyopathy in 36, coronary artery disease in 14), length of symptoms (20 ± 19 months, less than 6 months in 13 patients) or presence of murmurs (absent in 13 patients). Comparison of patients with nonischemic cardiomyopathy to those with ischemic heart disease revealed larger left ventricular volumes (215 ± 81 vs 131 ± 60 ml in systole, p <0.05) and left atrial volumes (124 ± 70 vs 70 ± 35 ml, p <0.05). Mitral anular dilatation was present only in patients with idiopathic cardiomyopathy (diameters 3.6 ± 0.4 vs 3.1 ± 0.2 cm, p <0.05). The frequency of significant MR in these patients with CHF suggests that it may have a major role in decompensation and in the therapeutic response.