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The vibratory innocent heart murmur in schoolchildren: difference in auscultatory findings between school medical officers and a pediatric cardiologist.

In 810 schoolchildren heart auscultation was performed by both a school medical officer (SMO) and a pediatric cardiologist (PC). The prevalence for a grade 1, 2, or 3 vibratory innocent heart murmur (VIHM), a grade 2 or 3 VIHM, and a grade 3 VIHM heard by the PC was 41%, 13%, and 1%, respectively. The SMO noted such murmurs in 26%, 9%, and 1%, respectively. In 30% of the cases in which the PC had noted a grade 2 or 3 VIHM, the SMO agreed; in 30% of such cases the SMO did not hear any heart murmur. If the PC heard a grade 2 or 3 VIHM phonocardiography was performed in a case-control study in which the controls did not have a heart murmur (94 pairs). In four children with a grade 2 or 3 VIHM no heart murmur could be registered and in three other children the murmur did not have the typical diamond shape. In contrast, in three children without a heart murmur at school a VIHM was seen on the phonocardiogram. In 26 children with a phonocardiographically proven grade 2 or 3 VIHM the SMO did not hear any heart murmur. One child with a grade 3 VIHM (both by the PC and SMO) had a minor subvalvular aortic stenosis. There is quite a difference in auscultatory detection of a venous hum: 9% (PC) and 2% (SMO). The prevalence of the pulmonary ejection murmur is identical at 4%. The carotid bruit is heard in 4% (PC) and 2% (SMO).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Right atrial myxoma in a patient with mood disturbances].

Cardiac myxomas represents 50% of the benign heart tumors. Right atrial myxomas are more rare than left localisations. Their major risks are in occurrence of pulmonary embolisms. The clinical features are non specific and the diagnosis is based on echocardiography. The treatment of choice for myxomas is surgical removal. We report a case of 32-year-old woman with an abnormality of the heart auscultation found when examined for humour disturbance. Echocardiography revealed a giant echogene, mass of the right atrium, prolapsing in the tricuspid orifice. Per-operative findings mentioned a mass with 10 cm of length. Anatomo-pathologic results conclude to atrial myxoma. The evolution after 8 months of surgical treatment was normalisation of heart auscultation and the improvement of the patient humour.

Adult↗

Cardiac gas embolism during carbon dioxide hysteroscopy: risk and management.

A relatively high number of fatal complications during hysteroscopy, where carbon dioxide was used as the uterine distension medium, plus a recent report on heart embolism during dog experiments with venous carbon dioxide infusion, audible by simple stethoscopic surveillance during the infusion, prompted the present study. Seventy women with no history of cardiac valvular disease or failure were observed during carbon dioxide hysteroscopy for the occurrence of the characteristic metallic heart sound caused by the intracardiac presence of free carbon dioxide during the heart contractions. In seven cases (10%) the typical metallic heart sounds appeared during the hysteroscopy, leading to immediate interruption of the hysteroscopy and withdrawal of the hysteroscope. This caused the pathological heart sounds to disappear, after which the hysteroscopy could continue. Heart auscultation should always be performed during carbon dioxide hysteroscopy in order to avoid serious cardiovascular complications. This simple precaution turns carbon dioxide hysteroscopy into a versatile and safe method for intra-uterine diagnosis and therapy.

Animals↗

Auscultation of foetal heart rate: an assessment of its error and significance.

AUSCULTATION OF FOETAL HEART RATE WAS SHOWN TO BE SUBJECT TO THREE TYPES OF ERROR: a random error, an error biased towards normality when the heart rate is fast or slow, and an error based on the inability to count the heart rate during contractions. In spite of these limitations a clinically observed foetal heart rate of more than 160 beats per minute was shown to be associated with significantly lower Apgar scores at birth. In contrast, a steady foetal heart rate of 100-120 beats per minute was not.

Electrocardiography↗