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At least 397 records · Page 22Linked to original sources
PubMed1996

Transvaginal versus transabdominal Doppler auscultation of fetal heart activity: a comparative study.

OBJECTIVE: Our purpose was to determine whether transvaginal Doppler auscultation is more sensitive than transabdominal auscultation for the detection of fetal heart rate in the first trimester of pregnancy. STUDY DESIGN: In a prospective study 141 patients between 6 weeks and 11 weeks 6 days of gestation underwent both transvaginal and transabdominal Doppler evaluation by use of continuous-wave Doppler instruments for detection of fetal heart rate. Transvaginal ultrasonography was used as the gold standard to establish fetal cardiac activity and to help assign gestational age. The two methods of auscultation were compared for accuracy in different gestational age ranges. Sensitivities and specificities were calculated, and associations were investigated with chi 2 analysis. The direction of disagreement between modalities was tested with the McNemar chi 2 test. RESULTS: Transvaginal auscultation outperformed transabdominal auscultation in every gestational age range. Transvaginal Doppler auscultation performed significantly better than transabdominal Doppler auscultation at 8 weeks to 8 weeks 6 days (p < or = 0.004) and 9 weeks to 9 weeks 6 days (p < or = 0.006). In pregnancies with cardiac activity, fetal heart rate can be successfully detected transvaginally in 60.5% of pregnancies at 8 weeks to 8 weeks 6 days and in 87.5% of pregnancies at 9 weeks to 9 weeks 6 days of gestation. This compares with successful transabdominal detection rates of 22.9% and 56% at 8 and 9 weeks, respectively. As gestational age advances both methods became increasingly sensitive for the detection of fetal heart rate. The earliest fetal heart rate detected transvaginally was at 6 weeks 0 days of gestation compared with 7 weeks 0 days transabdominally. The transvaginal Doppler method was also more successful in detecting the fetal heart rate in women with a retroverted uterus (p < or = 0.01). CONCLUSION: By use of continuous-wave Doppler instrumentation, transvaginal auscultation is significantly better than transabdominal auscultation in detecting fetal heart rate between 8 weeks to 8 weeks 6 days and 9 weeks to 9 weeks 6 days of gestation. Use of transvaginal auscultation has potential in the evaluation of first-trimester fetal cardiac activity.

Abdomen↗
PubMed2004

A decision tree--based method for the differential diagnosis of Aortic Stenosis from Mitral Regurgitation using heart sounds.

BACKGROUND: New technologies like echocardiography, color Doppler, CT, and MRI provide more direct and accurate evidence of heart disease than heart auscultation. However, these modalities are costly, large in size and operationally complex and therefore are not suitable for use in rural areas, in homecare and generally in primary healthcare set-ups. Furthermore the majority of internal medicine and cardiology training programs underestimate the value of cardiac auscultation and junior clinicians are not adequately trained in this field. Therefore efficient decision support systems would be very useful for supporting clinicians to make better heart sound diagnosis. In this study a rule-based method, based on decision trees, has been developed for differential diagnosis between "clear" Aortic Stenosis (AS) and "clear" Mitral Regurgitation (MR) using heart sounds. METHODS: For the purposes of our experiment we used a collection of 84 heart sound signals including 41 heart sound signals with "clear" AS systolic murmur and 43 with "clear" MR systolic murmur. Signals were initially preprocessed to detect 1st and 2nd heart sounds. Next a total of 100 features were determined for every heart sound signal and relevance to the differentiation between AS and MR was estimated. The performance of fully expanded decision tree classifiers and Pruned decision tree classifiers were studied based on various training and test datasets. Similarly, pruned decision tree classifiers were used to examine their differentiation capabilities. In order to build a generalized decision support system for heart sound diagnosis, we have divided the problem into sub problems, dealing with either one morphological characteristic of the heart-sound waveform or with difficult to distinguish cases. RESULTS: Relevance analysis on the different heart sound features demonstrated that the most relevant features are the frequency features and the morphological features that describe S1, S2 and the systolic murmur. The results are compatible with the physical understanding of the problem since AS and MR systolic murmurs have different frequency contents and different waveform shapes. On the contrary, in the diastolic phase there is no murmur in both diseases which results in the fact that the diastolic phase signals cannot contribute to the differentiation between AS and MR. We used a fully expanded decision tree classifier with a training set of 34 records and a test set of 50 records which resulted in a classification accuracy (total corrects/total tested) of 90% (45 correct/50 total records). Furthermore, the method proved to correctly classify both AS and MR cases since the partial AS and MR accuracies were 91.6% and 88.5% respectively. Similar accuracy was achieved using decision trees with a fraction of the 100 features (the most relevant). Pruned Differentiation decision trees did not significantly change the classification accuracy of the decision trees both in terms of partial classification and overall classification as well. DISCUSSION: Present work has indicated that decision tree algorithms decision tree algorithms can be successfully used as a basis for a decision support system to assist young and inexperienced clinicians to make better heart sound diagnosis. Furthermore, Relevance Analysis can be used to determine a small critical subset, from the initial set of features, which contains most of the information required for the differentiation. Decision tree structures, if properly trained can increase their classification accuracy in new test data sets. The classification accuracy and the generalization capabilities of the Fully Expanded decision tree structures and the Pruned decision tree structures have not significant difference for this examined sub-problem. However, the generalization capabilities of the decision tree based methods were found to be satisfactory. Decision tree structures were tested on various training and test data set and the classification accuracy was found to be consistently high.

Algorithms↗
PubMed2001

Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population.

OBJECTIVE: To compare the effect of admission cardiotocography and Doppler auscultation of the fetal heart on neonatal outcome and levels of obstetric intervention in a low risk obstetric population. DESIGN: Randomised controlled trial. SETTING: Obstetric unit of teaching hospital PARTICIPANTS: Pregnant women who had no obstetric complications that warranted continuous monitoring of fetal heart rate in labour. INTERVENTION: Women were randomised to receive either cardiotocography or Doppler auscultation of the fetal heart when they were admitted in spontaneous uncomplicated labour. MAIN OUTCOME MEASURES: The primary outcome measure was umbilical arterial metabolic acidosis. Secondary outcome measures included other measures of condition at birth and obstetric intervention. RESULTS: There were no significant differences in the incidence of metabolic acidosis or any other measure of neonatal outcome among women who remained at low risk when they were admitted in labour. However, compared with women who received Doppler auscultation, women who had admission cardiotocography were significantly more likely to have continuous fetal heart rate monitoring in labour (odds ratio 1.49, 95% confidence interval 1.26 to 1.76), augmentation of labour (1.26, 1.02 to 1.56), epidural analgesia (1.33, 1.10 to 1.61), and operative delivery (1.36, 1.12 to 1.65). CONCLUSIONS: Compared with Doppler auscultation of the fetal heart, admission cardiotocography does not benefit neonatal outcome in low risk women. Its use results in increased obstetric intervention, including operative delivery.

Acidosis↗
PubMedDate not supplied

Stab wound to the chest with acute pericardial tamponade.

A 21-year-old male presented to the trauma unit after he was stabbed once with a knife in the left anterior chest. The patient was awake and combative, very intoxicated, with a systolic blood pressure of 90 mmHg by palpation and a heart rate of 110 beats per min. Physical examination revealed distended neck veins, a single 1.5 cm stab wound to the left parasternal area at the third ICS (noted by clip on x-ray, Fig. 1), poorly auscultated heart sounds, and palpable femoral pulses that went away with inspiration. Chest radiograph (Fig. 1) showed a "pear-shaped" cardiac silhouette, though not markedly enlarged, and a significant left hemothorax. A diagnosis of acute pericardial tamponade was made, and the patient was taken immediately to the operating room for thoracotomy and successful repair of a stab wound of the right ventricle. Figure 2 (courtesy of Richard Wolfe, MD, Massachusetts General Hospital, Boston, MA) presents an example of an echocardiogram depicting a pericardial effusion. Pericardial fluid is imaged as a black (hypoechoic) crescent area separating the apex of the heart from the pericardium, seen as a white ring (arrow) at the inferior aspect of the scan. Tamponade is defined sonographically as the presence of both pericardial effusion (PE) and diastolic collapse of the right ventricle. Figure 3 (courtesy of Michael H. Picard, MD, of Harvard Medical School, Boston, MA) demonstrates the collapse of the right ventricular outflow track (RVOT) and its position relative to the left ventricle (LV), the left atrium (LA), and the aortic valve (AV).

Adult↗
PubMed2006

[Late heart evaluation of children with rheumatic mitral regurgitation submitted to reconstructive surgery with implantation of Gregori's ring].

OBJECTIVE: Assess late cardiological evolution of children with rheumatic mitral regurgitation (RMR) who underwent mitral valve reconstructive surgery with implantation of Gregori's ring (MVR), from 1987 to 2003. METHODS: A study was conducted to analyze a series of cases of 43 children with RMR who underwent MVR with ages ranged from five to twelve years (mean age 9.7 +/- 2.2 years); 25 of the patients were females (58.1%). Patients were evaluated as per the following clinical parameters: functional class of heart failure, heart auscultation, electrocardiogram, chest X-ray and echocardiographic findings. RESULTS: Forty-three patients underwent preoperative evaluation during the postoperative period, the number of patients evaluated decreased to 31 due to the fact that 6 patients had died and 6 others underwent valve replacement surgery. Follow-up was carried out for 100% of the patients. A significant reduction of heart failure functional class was observed. Mitral systolic murmur became less intense during the postoperative period. The cardiac area on chest X-ray and the presence of left ventricular overload on electrocardiogram were reduced, as well as the mitral regurgitation level on echocardiographic study. After 188 months, the survival rate was 82%, and the annual mortality rate, 0.38%. Thirty-one (72.6%) patients did not require reoperation and the annual rate of patients who required further surgery was 0.51%. CONCLUSION: MVR is an effective procedure for treating RMR in children, resulting in a significant improvement of functional class, mitral systolic murmur and level of mitral regurgitation, as shown on Doppler echocardiogram.

Child↗
PubMed1980

The cause and clinical significance of diastolic heart sounds.

Auscultation becomes more meaningful when the forces that cause the cardiac sounds are understood. We review the mechanisms responsible for the diastolic heart sounds and correlate them with various clinical conditions that affect their timing, loudness, and pitch. A careful search for these soft and illusive sounds should be included as part of every cardiac examination since their proper identification can supply important diagnostic and prognostic information.

Adult↗
PubMed2003

[Current views on acquired valvular heart disease and the results of treatment].

The article deals with the problems of diagnosis of acquired valvular defects (AVD) and indication to surgical treatment of AVD in accordance with international recommendations and modern knowledge of this issue. The following AVD diagnosis methods are described: heart auscultation, echocardiography, tests with regulated load, angiographic and radionuclide methods. Among pathological conditions, more attention is placed on stenoses, aortic, mitral and tricuspid valve insufficiency, IHD. Of importance is interpretation of the data obtained at diagnostic tests in terms of indications to cardiosurgical interventions, optimization of the terms and outcomes of the surgery. Statistics are provided on natural survival of patients and efficacy of surgical treatment.

Aortic Valve↗
PubMed1986

Double outlet right ventricle associated with persistent common atrioventricular canal and pulmonary stenosis.

A case of a month-old baby admitted for dyspnea and cyanosis, is described. His past history consisted of only mild cyanosis during crying. On physical examination nail beds and lips were cyanotic; on heart auscultation the pulmonary second sound was single. The chest X-ray showed a decreased pulmonary vascularity; the ECG demonstrated extreme right axis deviation (-170 degrees). Capillary gas analysis revealed hypoxic metabolic acidosis. Ten hours after his admission the child suddenly died. The anatomicopathological examination stated the diagnosis of double outlet right ventricle (DORV), infundibular pulmonary stenosis and common atrioventricular canal (transitional type). When clinical findings are compatible with DORV the ECG could be of value in establishing the presence of common atrioventricular canal when extreme right axis deviation is found.

Heart Defects, Congenital↗
PubMed1997

Primary hyperparathyroidism with cardiac abnormalities: a case report.

Primary hyperparathyroidism, characterized by hypersecretion of parathyroid hormone (PTH) leading to hypercalcemia and relative hypophosphatemia, is quite common in the elderly. Most patients with primary hyperparathyroidism have only mild hypercalcemia and are symptomless. But others experience various other organ diseases. Primary hyperparathyroidism is also associated with cardiovascular abnormalities, including QT interval shortening, heart block, cardiac arrhythmias, hypertension, myocardial hypertrophy, myocardial calcification and, though rarely, with valvular heart disease. We described a case of primary hyperparathyroidism associated with cardiac abnormalities. An 82-year-old male presented with the complaints of chest discomfort, fatigue, general weakness, nausea and vomiting over a period of months and was admitted in July 1996. Physical examination with heart auscultation showed a pansystolic murmur over the right sternal border and apex region, and a blowing diastolic murmur over the left sternal border. Biochemistry profiles revealed elevations of serum calcium (14.3 mg/dl) and chloride/phosphate ratio (> 33). Endocrinological studies showed elevations of serum PTH-C (4.8 ng/ml) and PTH-intact (705 pg/ml) concentrations. Kidney ultrasonography revealed a left renal stone. A spine X-ray revealed spondylosis and a compression fracture of the lumbar-spine with osteoporotic change. Thyroid ultrasonography and Thallium (Tl201)-technetium (Tc99m) subtraction scan showed parathyroid adenoma in the low pole of the right thyroid bed. Parathyroid aspiration cytology revealed few and discrete cells. Echocardiogram revealed moderate to severe aortic valvular calcification as well as stenosis with moderate aortic regurgitation, mitral regurgitation and myocardial calcification. The patient received parathyroidectomy one month later. During his postoperative days, he suffered from muscle twitching with positive Trousseau's sign and Chvostek's sign. The patient received calcium carbonate and vitamin D for hypocalcemia, diltiazem and capoten for his heart problems. A repeated echocardiogram two months after surgery showed no improvement of valvular calcification.

Aged↗
PubMed1999

[Prevalence study of congenital heart disease in children aged 0-2 in Zhejiang Province].

OBJECTIVE: To find out the prevalence rate of Congenital Heart Disease (CHD) among infants and toddlers. METHODS: Heart auscultation and echocardiography examination on children aged 0-2 were examined in 13 cities (or counties) in Zhejing province. RESULTS: Findings showed that the prevalence rate in children aged 0-2 was 3.72/1000. The prevalence rates of CHD were quite different among age groups with the highest (5.54/1000) in age group 0, followed by 3.36/1000 in age group 1 and lowest (2.66/1000) in age group 2. No significant difference of prevalence rates was found between different sex. Ventricular septal defects (59.4%) was noticed as the most common lesion. CONCLUSION: The evidence indicated that CHD is one of the most important problems of public health in China. Preventing its occurrence by conducting CHD surveillance and its etiologic research will have great significance for enhancing the qualities of life of children.

Child, Preschool↗