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At least 1,009 records · Page 56Linked to original sources
PubMed1995

Studies of temporomandibular joint sounds Part 3. The clinical usefulness of TMJ Doppler.

Doppler auscultation as applied to internal derangements of the TMJ has been developed in recent years. Possible clinical use of TMJ Doppler auscultation was examined by separating the signals into their spectral components, and comparing the results with those of the conventional sound amplification system (CSAS). Observing frequency component changes with time, similar observations were made using CSAS and TMJ Doppler. However, noises found in TMJ Doppler sonograms were markedly reduced in comparison with those found using CSAS. Ultrasonic waves have high directivity, and pass through soft tissue and fluid; however they have difficulty passing through air, and this may decrease the recording noise. TMJ Doppler can be applied to record movements of the condyle because changes in the receiving frequency indicate the movement of an observed object with precision.

Adult↗
PubMed2000

Prevalence and clinical importance of heart murmurs in racehorses.

OBJECTIVE: To determine the prevalence of various types of heart murmurs in Thoroughbred racehorses and assess their association with performance by echocardiography and review of the horses' race records for the preceding 2 years. DESIGN: Clinical and retrospective study. ANIMALS: 846 Thoroughbred racehorses. PROCEDURE: Cardiac auscultations were performed by 3 individuals; for 30 horses, Doppler echocardiographic examinations were also performed. Statistical analyses of race records for 753 horses were performed to assess association of heart murmurs with performance. RESULTS: Heart murmurs were detected by cardiac auscultation in 686 of 846 (81.1%) horses. Systolic murmurs over the heart base were most common; 365 (43.1%) horses had systolic murmurs that were loudest over the pulmonary valve area, and 232 (27.4%) horses had systolic murmurs that were loudest over the aortic valve area. Systolic murmurs over the tricuspid valve area were detected in 241 (28.5%) horses, whereas systolic murmurs over the mitral valve area were detected in only 32 (3.8%) horses. Diastolic murmurs were much less common than systolic murmurs. Review of race records did not reveal a significant association between murmurs and performance. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that heart murmurs are a common finding in racehorses; most of these heart murmurs do not appear to be clinically important.

Age Factors↗
PubMed2000

Current management of mitral valve prolapse.

Mitral valve prolapse is a pathologic anatomic and physiologic abnormality of the mitral valve apparatus affecting mitral leaflet motion. "Mitral valve prolapse syndrome" is a term often used to describe a constellation of mitral valve prolapse and associated symptoms or other physical abnormalities such as autonomic dysfunction, palpitations and pectus excavatum. The importance of recognizing that mitral valve prolapse may occur as an isolated disorder or with other coincident findings has led to the use of both terms. Mitral valve prolapse syndrome, which occurs in 3 to 6 percent of Americans, is caused by a systolic billowing of one or both mitral leaflets into the left atrium, with or without mitral regurgitation. It is often discovered during routine cardiac auscultation or when echocardiography is performed for another reason. Most patients with mitral valve prolapse are asymptomatic. Those who have symptoms commonly report chest discomfort, anxiety, fatigue and dyspnea, but whether these are actually due to mitral valve prolapse is not certain. The principal physical finding is a midsystolic click, which frequently is followed by a late systolic murmur. Although echocardiography is the most useful mode for identifying mitral valve prolapse, it is not recommended as a screening tool for mitral valve prolapse in patients who have no systolic click or murmur on careful auscultation. Mitral valve prolapse has a benign prognosis and a complication rate of 2 percent per year. The progression of mitral regurgitation may cause dilation of the left-sided heart chambers. Infective endocarditis is a potential complication. Patients with mitral valve prolapse syndrome who have murmurs and/or thickened redundant leaflets seen on echocardiography should receive antibiotic prophylaxis against endocarditis.

Diagnosis, Differential↗
PubMed2001

Cardiac auscultatory recording database: delivering heart sounds through the Internet.

The clinical skill of cardiac auscultation, while known to be sensitive, specific, and inexpensive in screening for cardiac disease among children, has recently been shown to be deficient among residents in training. This decline in clinical skill is partly due to the difficulty in teaching auscultation. Standardization, depth, and breadth of experience has been difficult to reproduce for students due to time constraints and the impracticality of examining large numbers of patients with cardiac pathology. We have developed a web-based multimedia platform that delivers complete heart sound recordings from over 800 different patients seen at the Johns Hopkins Outpatient Pediatric Cardiology Clinic. The database represents more than twenty significant cardiac lesions as well as normal and innocent murmurs. Each patient record is complete with a gold standard echo for diagnostic confirmation and a gold standard auscultatory assessment provided by a pediatric cardiology attending.

Adult↗
PubMed2003

Auscultatory percussion: an added dimension in physical diagnosis.

The combination of both auscultation and percussion in the diagnostic examination improves both auscultation and percussion and, in so doing, increases the skill of palpation. Auscultatory percussion (AP) is easy to learn, easy to use and requires little time to perform. The size of normal organs and the size of abnormal masses as determined by AP are usually similar to measurements determined by X-rays and CT scans. Abnormalities found by AP need to be evaluated and confirmed by other diagnostic procedures. AP brings increased precision to physical diagnosis and is felt to be a valuable addition to medical practice.

Abdomen↗
PubMed2003

[May heart murmurs be assessed by telemedicine?].

BACKGROUND: Children often have heart murmurs; referral to a specialist is common. A service for remote auscultation of heart murmurs was established in which heart sounds and short texts were sent as attachment to e-mails. Our aim was to assess the quality of this method. MATERIAL AND METHODS: Heart sounds from 47 patients with no murmur (n = 7), innocent murmurs (n = 20), or with pathological murmurs (n = 20) were recorded using a sensor-based stethoscope and e-mailed to a computer. The sounds were repeated giving 100 cases, randomly distributed on a CD. Four specialists categorised the cases as having "no murmur", "innocent murmur", or "pathological murmur", recorded assessment time, degree of certainty, and need for referral. RESULTS: On average 2.1 minutes were spent on each case. Mean sensitivity and specificity were 90% and 98%, respectively. Inter- and intra-observer variability were low (kappa 0.81 and 0.87). 93% of cases with a pathological murmur and 13% with an innocent murmur were recommended for referral. INTERPRETATION: Telemedical referral of children with heart murmurs to a cardiologist is safe, reduces travelling, and saves time. Skilled auscultation is adequate to detect those with innocent murmurs.

Electronic Mail↗
PubMed2004

Clinical significance and prognosis of fetal arrhythmias.

OBJECTIVE: To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis. METHODS: Twenty-six cases of fetal arrhythmia detected among 12,799 pregnant women recorded over a ten-year period in Peking Uinon Medical College (PUMC) Hospital were reviewed retrospectively. Fetal arrhythmia was diagnosed by fetal auscultation, ultrasonography, electric fetal heart monitoring, and fetal echocardiography. RESULTS: Twenty-six fetuses were documented with fetal arrhythmia (3 tachycardia, 4 bradycardia, 19 normal heart rate with irregular fetal cardiac rhythm). The incidence of fetal arrhythmia in our hospital was 0.2%. They were diagnosed at the average of 35 weeks' gestation (15 to 41 weeks). Twenty-two cases were diagnosed by antenatal fetal auscultation, 1 case was diagnosed by ultrasonography, and 3 cases were diagnosed by electric fetal heart monitoring. Fetal echocardiograms were performed on 17 fetuses, 6 cases (35.3%) of which showed that ventricular premature beats with normal structure of fetal heart. All neonates survived postnatally and 24 of them (92.3%) were followed up. Echocardiograms were performed for 16 neonates and 2 of them were identified as atrial septal defects with normal heart rhythms. The results of follow-up showed that the two patients had no apparent clinical manifestation. The echocardiogram showed that atrial septal defect obliterated already. CONCLUSION: The prognosis is well for most of the fetuses with arrhythmias, with low incidence of heart deformation.

Arrhythmias, Cardiac↗
PubMed1991

[Use of fetal heart rate scoring system in intrapartum fetal monitoring].

A scoring system of intermittent 5-second successive fetal heart rate auscultation was devised for intrapartum fetal monitoring. Its use among 150 cases in two hospitals, yielded a negative predictive rate of 93.8% and a positive rate of 71.4%, higher than that of the routine auscultation method. The scoring system was also well correlated with the umbilical blood gases values. Hence, it is recommended for intrapartum fetal monitoring, especially, where electronic monitoring is not available.

Blood Gas Analysis↗
PubMed1991

The change in prevalence of wheeze in seven year old children over 19 years.

OBJECT: to determine the change in prevalence of wheeze on clinical examination and history over a 19 year period. METHODS: a survey of random samples of seven year old children at primary schools in an urban area (Hutt Valley). Outcome measures were answers to a questionnaire and auscultation of children's chest for wheeze. RESULTS: in 1971, 1981, and 1990, the point prevalence of clinical wheeze by auscultation remained steady between 3.2% and 5.9%. However there was a significant increase in the prevalence of reported wheeze from 23% to 36% (p less than 0.001). Between 1981 and 1990 there was a 10.7% increase in the number of children who had been to their general practitioner for wheeze (p less than 0.001), a 5.3% increase in children who were on daily medication (p less than 0.001) and a 8.2% increase in the family history of asthma (p less than 0.001). There was no significant increase in the number of children who had been to hospital for wheezing. The proportion of children who were found to be wheezing on the day and whose parents did not identify a problem in their child had not changed between 1981 and 1990. CONCLUSION: there was an increasing high level of wheeze reported in the Hutt Valley with a corresponding steady level of clinical wheeze. More educational efforts are needed by primary health care workers to improve on parental perception of wheeze because a steady third of those children who were found to be clinically wheezing were recognised by their parents to have a problem.

Asthma↗
PubMed1989

[Computer-assisted drug therapy of incomplete ileus].

Auscultation of bowel sounds has a decisive position in management of intestinal paralysis, although personal bound interpretation and documentation may give rise to problems. Our computerized electronic analysis system of bowel sounds permits easy objectivation of auscultation findings. This noninvasive method is optional a repeatable. We investigated 15 patients suffering from intestinal paralysis using this method. Good correlations between clinical findings and the results of our analysis allow reliable estimations of therapeutic measurements. Dosage of drugs influencing peristalsis is facilitated.

Auscultation↗
PubMed1987

The cardiac exam in lung disease.

The physical examination, that is, inspection, palpation, and auscultation, is as valuable today as it ever was, even for structures as inaccessible as the heart and pulmonary circulation. Examination of the heart in patients with lung disease aims to detect changes in the structures or function of the right heart that are secondary to the pulmonary process and to detect the circulatory status of the patient. The most important cause of changes in the right ventricle in patients with lung disease is increased afterload caused by pulmonary hypertension. Auscultation remains one of the most sensitive means of detecting pulmonary hypertension, and the physical signs allow assessment of right ventricular function as well as response to therapy.

Heart Auscultation↗
PubMed1987

Phonocardiogram signal analysis: a review.

Many disease of the heart cause changes in heart sounds and additional murmurs before other signs and symptoms appear. Hence, heart sound analysis by auscultation is the primary test conducted by physicians to assess the condition of the heart. Yet, heart sound analysis by auscultation as well as analysis of the phonocardiogram (PCG) signal have not gained widespread acceptance. This is due mainly to many controversies regarding the genesis of the sounds and the lack of quantitative techniques for reliable analysis of the signal features. The heart sound signal has much more information than can be assessed by the human ear or by visual inspection of the signal tracings on paper as currently practiced. Here, we review the nature of the heart sound signal and the various signal-processing techniques that have been applied to PCG analysis. Some new research directions are also outlined.

Cardiovascular Physiological Phenomena↗
PubMed1988

[Unrecognized esophageal intubation. Consideration of prevention in a case].

A case of unrecognized esophageal intubation is presented to point out that auscultation of the chest is not a reliable method for proving the correct position of the endotracheal tube in every case. Because of auscultatory findings in this case of a 47-year-old women, several warning signs were discarded: (1) the surgeons questioned about the possibility of ventilating the stomach during preparation for an abdominal hysterectomy; (2) failure of measuring expired CO2 with an infrared CO2 analyzer, which then was called defective; (3) cyanotic blood at skin incision. All signs were denied by the anesthesiologist after having repeatedly auscultated the chest and being sure of hearing normal breath sounds. Although in his 1st year of anesthesia training, he did not feel it was necessary to call the supervising anesthesiologist. At the time of cardiac arrest about 15 min after intubation, the incorrect tube position was discovered and corrected. Despite successful cardiac resuscitation, the patient did not regain consciousness and died 9 months later. The only reliable means of being sure that tube position is correct is to repeat direct laryngoscopy and visualize the tube inside the glottis or, alternatively, to perform expiratory CO2 measurement.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1987

[Correlations between the features of first heart sound and opening snap and the shape and motion of the anterior mitral leaflet in patients with mitral stenosis].

To evaluate the relationship between the motion pattern and degree of organic change of the anterior mitral leaflet (AML) and the features of the mitral component of the first heart sound (M1) or the opening snap (OS), 37 patients with mitral stenosis (MS) were studied by auscultation, phonocardiography and echocardiography. Based on the features of M1 and OS according to auscultation and phonocardiography, the patients were categorized as group I, 18 patients with loud and snappy M1 and OS; group II, 12 patients with snappy M1 but small and dull OS; and group III, seven patients with small and dull M1 and OS. Intensities of M1 and OS were calculated by the ratios of their amplitudes to the aortic component of the second heart sound on the high frequency phonocardiograms recorded at points of the maximum intensities, respectively. Echocardiographic parameters related to productions of M1 and OS were obtained from M-mode and two-dimensional echograms of the AML; they were amplitudes and velocities on closing and opening, M1 area defined as that between end-diastolic and systolic echoes, OS area between systolic and early diastolic echoes, the doming area between the trailing edge of an early diastolic echo and a line projected from the anterior annulus to the tip of the leaflet, and the degree of systolic ballooning. Results were as follows: 1. Significant differences in the area of the mitral valve orifice were found among three groups. The area was maximum in group II, minimum in group III and intermediate in group I. 2. In group I, the body of the AML was pliable, resulting in a ballooning into the left atrium in systole and a marked doming toward the left ventricle in early diastole. Various parameters related to the production of M1 and OS in group I were significantly increased as compared with those of the other two groups. 3. In group II, the body of the AML was not pliable in spite of mild organic changes in the valve. The degree of early diastolic doming was mild. Compared to group III, the intensity of M1 in group II was significantly larger, but no significant difference was observed in the parameters related to the production of M1 between the two groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

Normal and pathological bowel sound patterns.

The purpose of this study was to determine the usefulness of auscultation of bowel sounds in evaluating patients with total and subtotal small intestinal obstruction and immediately after operation. The study was based on ten healthy volunteers, seven patients with documented mechanical obstruction, one patient with chronic subtotal mechanical obstruction and twelve patients undergoing an emergency laparotomy. Bowel sounds varied markedly in all individuals studied. The most striking finding in mechanical obstruction was the regular occurrence of clustered bowel sounds. These were defined as 3-10 regular sounds, occurring one every five seconds, preceded and followed by at least one minute of silence. The associated periods of quiescent motor activity may account for the unexpectedly reduced frequency and motility index after a meal in obstructed patients compared with normal subjects. The different bowel sound patterns occurred in the patient with subtotal mechanical obstruction before and after a meal respectively i.e. infrequent and low-amplitude bowel sounds and clustered bowel sounds. The technique is probably not more sensitive than radiological procedures, and the abnormalities that are detected by an auscultation of bowel sounds are not specific.

Adult↗
PubMed1979

Bedside maneuvers in the diagnosis of heart disease.

Numerous other pathologic conditions are encountered. The relatively few maneuvers and drugs presented here were chosen as the ones most commonly used in daily practice. Cardiac auscultation is just one aspect of the cardiovascular examination; equal attention should be paid to determination of jugular venous pressure, jugular venous wave form, carotid upstroke characteristics, and to observation and palpation of the precordium. Finally, if the examiner keeps in mind the hemodynamic changes induced by the various maneuvers and pharmacologic agents while auscultating the heart, and if he understands the pathophysiology of the commonly encountered cardiac lesions, he should be able to diagnose heart disease and to evaluate more intelligently various murmurs and heart sounds without necessitating the use of expensive invasive or noninvasive procedures.

Adolescent↗
PubMed1982

[Comparison of various methods of diagnosis of the mitral valve (author's transl)].

This study compares the information supplied by auscultation, echocardiography and left ventriculography in the diagnosis of mitral prolapse from a study of the world literature and a personal study. A click on auscultation or a telesystolic click murmur is noted in almost 74 p. cent of cases. Echocardiography may lead to false negatives in partial prolapse of the posterior valve and in ventriculography, even judged according to strict and restrictive criteria they may make errors by excess. Telemetric echocardiography may assess in an overall way the number or prolapsed valvular structures and the degree of mitral incompetence. The respective indications of the 3 methods are given in detail.

Echocardiography↗
PubMed1983

Non invasive assessment of the internal carotid artery in stroke patients.

The internal carotid arteries were evaluated with Doppler ultrasound technique in patients with acute cerebrovascular disease. The results of the Doppler examination of 325 vessels were compared to presence of carotid bruits on auscultation. In 126 arteries the findings were also compared with those on aortocervical, single carotid or post-mortal angiography. The Doppler flow reaction was normal in 74% of the vessels, uncertain in 20% and pathologic in 6%. The sensitivity of the Doppler assessment in finding stenosis of more than 75% lumen diameter reduction was 85% with a specificity of 94%. The specificity increased with higher degree of vascular stenosis. Carotid bruits were heard in 34 arteries. The sensitivity of auscultation in detecting stenosis 75% was 47% with a specificity of 83%. The sensitivity fell with higher degree of stenosis. The Doppler procedure is a valuable tool in detecting haemodynamically significant stenoses in the internal carotid artery. The method could serve the following purposes in the clinical situation: 1. Screening procedure for further investigations in TIA and minor stroke patients fit enough to be candidates for vascular surgery. 2. Before blood-pressure can be safely reduced in patients with cerebrovascular disease. 3. For evaluation of the arteriosclerotic process in stroke-patients thereby improving prognostication.

Adult↗