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PubMed1993

Implications of an audible third heart sound in evaluating cardiac function.

We prospectively compared auscultatory findings of third heart sounds with radionuclide ventriculographic analysis of systolic and diastolic function. Cardiac auscultation was done to detect an S3 in patients referred for radionuclide ventriculographic analysis of ventricular function. Of 49 adult men with the diagnosis of chronic, nonvalvular heart failure who were referred for the evaluation of heart failure, 22 (45%) at the time of the ventriculography had an S3 present on examination. For the entire study group, the radionuclide ventriculography-derived ejection fraction was 33% +/- 19.5 (mean +/- SD) with a range of 6% to 74%. The peak ejection rate was 2.05 +/- 1.09 end-diastolic volume per second with a range of 0.30 to 4.56. The peak filling rate was 1.97 +/- 1.07 end-diastolic volume per second with a range of 0.44 to 3.94, and the time to peak filling rate was 0.18 +/- 0.11 per second with a range of 0.05 to 0.61. The presence of an S3 was associated with a reduced ejection fraction and also with impaired diastolic function as determined by the peak filling rate. The sensitivity and specificity for the S3 in detecting abnormal systolic function (ejection fraction < 50%) were 51% and 90%, respectively, with a positive predictive value of 95% and a negative predictive value of only 32%. For an ejection fraction of less than 30%, the S3 had a sensitivity and specificity of 78% and 88%. The presence of an S3 was highly predictive of an abnormal ejection fraction. The absence of an S3, however, is not uncommon in patients with a mildly impaired ejection fraction.

Aged↗
PubMed1993

[Blood pressure recording in outpatient service: experience with the Sandoz Pressure System].

The Sandoz Pressure System (SPS) is a widely used device for ambulatory blood pressure recording. The accuracy of blood pressure profiles recorded in daily routine with this device has been demonstrated. In 34 untreated hypertensive patients the blood pressure values were in good agreement with measurements taken by auscultation. The variability of recordings was less or equal to 5 mmHg in 10% of patients for the systolic and in 94% of patients for the diastolic value. During daily activity 100 +/- 6% (mean +/- standard deviation) of the values expected by programming were available for analysis. These results confirm that arterial pressure under ambulatory conditions cannot be reliably predicted based on blood pressure measurements in the doctor's office.

Adult↗
PubMedDate not supplied

Transbronchial intubation of the right pleural space: a rare complication of nasogastric intubation with a polyvinylchloride tube--a case study.

Inappropriate intubation of the tracheobronchial tree by a fine-bore nasogastric tube with a metal stylet is a well-known hazard. We report a pulmonary perforation and hydropneumothorax caused by a polyvinylchloride nasogastric tube without a stylet in a child of 13 months. The position of the tube was checked by auscultation before feeding. It would appear that the auscultatory method is inadequate in checking the correct placement of a nasogastric tube in young children. An ordinary nasogastric tube can cause pulmonary perforation.

Auscultation↗
PubMed1977

Carotid bruit as a risk factor in aortoiliac reconstruction.

Records of 248 patients undergoing aortoiliac reconstruction for occlusive disease between 1957 and 1975 were reviewed. Carotid bruits were ausculted in 35 patients (14%). Five of the patients with bruits also were thought to have symptoms of transient ischemia. Strokes occurred after operation in four of the 248 patients (1.6%). No patient with a previously noted bruit developed postoperative stroke. Two patients with transient cerebral ischemia and no confirmed bruit before operation did develop postoperative strokes. Cerebral angiography was performed in 18 of the patients with carotid bruits. Two of these patients underwent carotid endarterectomy prior to aortoiliac reconstruction. None of these 18 patients developed strokes following their carotid surgery of aortoiliac reconstruction. A third patient with no bruit but with retinal cholesterol emboli also underwent arteriography and endarterectomy without complication. The results suggest that the asymptomatic carotid bruit alone does not indicate an increased risk of stroke during aortoiliac reconstruction. The authors conclude that their experience does not support prophylactic carotid endarterectomy in the asymptomatic patient prior to aortoiliac reconstruction.

Aorta↗
PubMed1995

Xinyinqin: a computer-based heart sound simulator.

"Xinyinqin" is the Chinese phoneticized name of the Heart Sound Simulator (HSS). The "qin" in "Xinyinqin" is the Chinese name of a category of musical instruments, which means that the operation of HSS is very convenient--like playing an electric piano with the keys. HSS is connected to the GAME I/O of an Apple microcomputer. The generation of sound is controlled by a program. Xinyinqin is used as a teaching aid of Diagnostics. It has been applied in teaching for three years. In this demonstration we will introduce the following functions of HSS: 1) The main program has two modules. The first one is the heart auscultation training module. HSS can output a heart sound selected by the student. Another program module is used to test the student's learning condition. The computer can randomly simulate a certain heart sound and ask the student to name it. The computer gives the student's answer an assessment: "correct" or "incorrect." When the answer is incorrect, the computer will output that heart sound again for the student to listen to; this process is repeated until she correctly identifies it. 2) The program is convenient to use and easy to control. By pressing the S key, it is able to output a slow heart rate until the student can clearly identify the rhythm. The heart rate, like the actual rate of a patient, can then be restored by hitting any key. By pressing the SPACE BAR, the heart sound output can be stopped to allow the teacher to explain something to the student. The teacher can resume playing the heart sound again by hitting any key; she can also change the content of the training by hitting RETURN key. In the future, we plan to simulate more heart sounds and incorporate relevant graphs.

Computer Simulation↗
PubMed1997

Pediatric cardiovascular assessment and referral in the primary care setting.

Pediatric cardiovascular problems, although not common, have the potential to have significant associated morbidity and mortality if they go unrecognized. This article focuses on pediatric assessment techniques required to perform a comprehensive cardiovascular evaluation on an infant or an older child in the primary care setting. Specific key physical assessment parameters to be evaluated and a general developmental approach to the assessment of children are suggested. Auscultation of the pediatric heart is a main focus, including strategies in approaching children, a guide for organizing the ausculatory process, and differences between adult and pediatric heart sounds. Assessment of peripheral pulses, blood pressure, skin and mucous membrane color, and capillary refill are emphasized as an important aspect of comprehensive evaluation of the child's peripheral circulation. Criteria for referral are provided in terms of which children should be referred, who the referral should be made to, and the time frame in which the referral should be made.

Cardiovascular Diseases↗
PubMedDate not supplied

Evaluation of instruments for noninvasive blood pressure monitoring of the wrist.

Commercially-available electronic, digital, oscillometric instruments for monitoring wrist blood pressure (BP) are intended for use by the general public in home health care. The purpose of this study was to evaluate the performance of these instruments for accuracy, reliability, and failure rate. Blood pressure and heart rate (HR) measurements from the new wrist instruments were compared with sequentially recorded BPs determined by auscultation of the branchial artery and HRs determined by palpation of the radial artery. Accuracy and reliability were determined using linear regression, correlation coefficients, and standard error of the estimates. The wrist BP instruments were very easy to use on a variety of individuals. No failure to record a BP or HR was observed. The wrist devices appeared less accurate than the standard, branchial-artery, ausculatory method. The wrist BP instruments tended to overestimate hypotensive and significantly under estimate hypertensive BPs. The wrist device's HR accuracy and reliability appeared to approximate that of the standard method.

Adolescent↗
PubMed1997

Cardiac auscultatory skills of internal medicine and family practice trainees. A comparison of diagnostic proficiency.

CONTEXT: Medical educators have had a growing sense that proficiency in physical diagnostic skills is waning, but few data have examined the question critically. OBJECTIVE, DESIGN, AND SETTING: To compare the cardiac auscultatory proficiency of medical students and physicians in training. A multicenter cross-sectional assessment of students and house staff. A total of 8 internal medicine and 23 family practice programs of the mid-Atlantic area. PARTICIPANTS: A total of 453 physicians in training and 88 medical students. INTERVENTIONS: All participants listened to 12 cardiac events directly recorded from patients, which they identified by completing a multiple-choice questionnaire. MAIN OUTCOME MEASURES: scores were expressed as the percentage of participants, for year and type of training, who correctly identified each event. Cumulative scores were expressed as the total number of events correctly recognized. An adjusted score was calculated whenever participants selected not only the correct finding but also findings that are acoustically similar and yet absent. RESULTS: Trainees' cumulative scores ranged between 0 and 7 for both internal medicine and family practice residents (median, 2.5 and 2.0, respectively). Internal medicine residents had the highest cumulative adjusted scores for the 6 extra sounds and for all 12 cardiac events tested (P=.01 and .02, respectively). On average, internal medicine and family practice residents recognized 20% of all cardiac events; the number of correct identifications improved little with year of training and was not significantly higher than the number identified by medical students. CONCLUSIONS: Both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events. This study suggests a need to improve the teaching and assessment of cardiac auscultation during generalists' training, particularly with the advent of managed care and its search for more cost-effective uses of technology.

Clinical Competence↗
PubMed1977

Carotid bruits: their significance in the cervical radicular syndrome.

Routine physical examination of 600 patients referred with complaints of neck or shoulder pain included auscultation of both carotid and subclavian arteries. A treatment regimen including consideration of therapeutic cervical traction was precluded in 11 patients when unilateral carotid bruits were heard. Subsequent testing including radioisotopic carotid blood flow studies, and arteriography demonstrated 1 thoracic outlet syndrome, 1 arteriovenous malformation, 1 scarring secondary to radical neck dissection, 1 extrinsic pressure from an epidermoid carcinoma, 5 partial carotid occlusions secondary to intra-arterial plaque formation, and 2 normal carotid contrast studies. Successful surgery in all five of the stenotic patients and in the case of arteriovenous malformation aborted what might have otherwise been a less satisfactory outcome.

Adult↗
PubMed1997

Clinical comparison of magnetic resonance imaging and nuclear emission imaging in cervical-facial trauma patients.

This retrospective study examined 20 consecutively treated trauma patients who reported a chief complaint of earache or trauma preauricular pain. These individuals were examined with magnetic resonance imaging (MRI), emission study using single photon emission, computerized tomography, and joints auscultation using Doppler sound magnification. There are no statistically significant correlations between clinical findings and imaging studies in trauma patients with complaints of earaches and preauricular pain.

Adolescent↗
PubMed1998

[Clinical evaluation of hepatic bruit audible in patients with alcoholic hepatitis].

It is well accepted that many patients with alcoholic hepatitis have an audible bruit over the liver (hepatic bruit) in western countries. However, this sign has not been discussed in Japan. The aim of this study was to assess the significance of the hepatic bruit in Japanese patients with alcoholic hepatitis. Hepatic bruit was specifically searched for on auscultation by two physician in consecutive patients (6 alcoholic hepatitis, 58 other alcoholic liver disease, 128 nonalcoholic liver disease including 16 hepatocellular carcinoma). Hepatic bruit was detected in 5 of 6 (83%) patients with alcoholic hepatitis, and in 1 of 16 (6%) patients with hepatocellular carcinoma. In any of other liver diseases, hepatic bruit was not detected. We conclude that hepatic bruit may be an important diagnostic finding in Japanese patient with alcoholic hepatitis as it is in western countries.

Adult↗
PubMed1998

Ten-year blood pressure trends in nonhypertensive inhabitants of La Plata, Argentina.

OBJECTIVES: To compare, according to blood pressure (BP) categories, 10-year trends in BP measurements in nonhypertensive subjects and the relative risk of developing hypertension. DESIGN: Population study. BP was recorded as the average of two measures taken on a single occasion with a mercury sphygmomanometer and the auscultation method. SETTING: Residents of La Plata, aged 15 to 64 years. PARTICIPANTS: The study was based on randomly chosen individuals who, during a previous survey in 1985, were 15 to 64 years old and whose BP was below 140/90 mmHg. They were grouped according to sex and BP categories. Random age- and sex-stratified sampling of 151 men and 193 women was performed. Categories were high normal BP, optimal BP (as defined by the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure) and normal but not optimal BP defined as BP 120 to 129/80 to 84 mmHg. RESULTS: BP increased in all categories; this increase was significant (P < 0.01) except for diastolic BP in women with high normal BP. BP increases were higher in optimal BP subjects and lower in high normal BP subjects (P < 0.01 for women and not significant for men). The relative risk of developing hypertension in high normal BP subjects was triple that in optimal BP subjects (P < 0.01). CONCLUSIONS: Increases in BP observed in optimal BP subjects stress the importance of monitoring BP changes and recommending primary prevention in the whole population.

Adolescent↗
PubMed1998

Atrioventricular septal defects in three llamas (Lama glama).

Two half-sibling neonatal llamas (Lama glama) and one unrelated adult llama were presented with various complaints, including failure to thrive, respiratory distress, and excessive recumbency. The related camelids were born in successive years to the same dam but from unrelated sires. Thoracic auscultation revealed significant systolic and diastolic murmurs on both sides of the chest in all three llamas, and arterial blood gas evaluation revealed hypoxemia in two llamas. Echocardiographic examinations revealed large atrioventricular septal (AVS) defects in all three llamas. Two llamas were euthanized after diagnosis and the third died 4 mo later. Postmortem examination confirmed large AVS defects in all animals. There also was marked cardiomegaly in each animal. The discovery of such a cardiac anomaly in these three camelids suggests that it may be common in this species and may have a genetic basis.

Animals↗
PubMed1998

Cardiovascular assessment for home healthcare nurses. Part II: Assessing blood pressure and cardiac function.

In Part I of this two-part series on cardiovascular assessment, the author described basic components of physical assessment relating to cardiac assessment such as skin color, integrity and hydration, pulses, shortness of breath, edema, and weight changes. In Part II, the intricacies of accurate blood pressure measurement, central venous pressure measurement, and heart and lung auscultation are described. Medication management and documentation within the context of home healthcare are also discussed.

Auscultation↗
PubMed1993

Physicians treating their own children.

OBJECTIVES: To determine the types of health care interventions physicians provided to their own children, identify those conditions most often treated by physician-parents, compare the differences in treatment practices among physician groups, and explore the reasons physicians give for treating their own children. DESIGN: Questionnaire. SETTING: University-affiliated teaching hospital in Iowa City, Iowa. PARTICIPANTS: Three hundred fifty-three physicians in residency and fellowship training and faculty who were parents of children aged 18 years or younger. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: The majority of physicians reported treating their afebrile child for acute illness. Fifty-five percent of physicians reported that they rarely or never treated their febrile child (temperature > 38.3 degrees C) without consultation with the child's physician. Only 47% of physicians reported that they always performed a physical examination on their child before treating. Physician-parents were more likely to auscultate the child's chest or perform otoscopy and less likely to obtain urine samples or throat swabs for culture before treating. Sixty-two percent of physicians reported that they have never performed routine health maintenance examinations on their own children, but 29% referred their children to a specialist. Medications were prescribed for their children by 65% of physicians. Neither gender nor level of training influenced the treatment practices of physician-parents. Primary care physicians were less likely to contact the child's physician for advice in treating their febrile child than were subspecialists. Pediatricians more often treated their afebrile and febrile children, performed physical examinations and laboratory studies, and prescribed medications than did other primary care physicians. Convenience was the most important reason physicians gave for treating their own children. CONCLUSIONS: Physicians frequently treat their own ill children, prescribe medications for them, and self-refer them to specialists largely for the sake of convenience.

Adolescent↗
PubMed1976

Fatal pulmonary reaction from low doses of bleomycin. An idiosyncratic tissue response.

There were two cases of fatal interstitial pneumonia secondary to bleomycin sulfate administration. Although bleomycin pulmonary toxicity is generally thought to be dose-related and occurs infrequently with a total cummulative dose less than 300 to 400 units, the two reactions reported here occurred with doses of 105 and 165 units. Fatal bleomycin-induced pneumonia has been previously reported at these low dosages, and physicians should be aware that this toxic reaction may occur as an idiosyncratic response. Previous thoracic irradiation may be a predisposing factor. Patients receiving bleomycin should be meticulously monitored by interrogation for cough, dyspnea, and chest pain; by auscultation for rales; by serial chest roentgenograms; and by determinations of vital capacity and single-breath carbon monoxide diffusing capacity.

Adenocarcinoma↗
PubMed1996

Sickle cell acute chest syndrome associated with parvovirus B19 infection: case series and review.

Acute Chest Syndrome (ACS) continues to be a major source of morbidity and mortality among patients with sickle cell disease. It is characterized by the presence of pleuritic chest pain, fever, raises on lung auscultation, and pulmonary infiltrates on chest x-ray [Castro et all: Blood 84:643-649]. The pathophysiology of this disorder remains poorly understood leading to the descriptive term "Acute Chest Syndrome" designated by Charache et al. [Arch Intern Med 139:67-69, 1979]. Typical bacterial pathogens are seldom isolated in adults, although they play a significant role in the pathogenesis of this entity in children. Until recently, the technology to accurately study viral infection as a precipitating cause of ACS has been unavailable. Parvovirus B19 is being increasingly recognized as an important human pathogen, and has been established as the cause of transient "aplastic crisis" in patients with sickle cell diseases [Saarien et al: Blood 67:-11411-11417, 1986; Young: Sem Hematol 25:159-172, 1988]. We present three patients with hemoglobin SC variant of sickle cell disease who developed ACS in association with acute parvovirus B19 infection, one of which died of respiratory failure. Parvovirus B19 infection was established by polymerase chain reaction for parvovirus B19 DNA, and the presence of parvovirus B19 specific IgM antibodies. These cases suggest that parvovirus B19 may be associated with more than self-limited illness in patients with sickle cell disease, and that this ubiquitous virus may merit further study as a precipitating cause of ACS.

Acute Disease↗
PubMedDate not supplied

Effect of vacuum extraction on umbilical cord blood acid-base measurements.

The objective of this study was to determine whether vacuum extraction is associated with umbilical cord blood acid-base changes when used electively or in the presence of suspected fetal distress. Data from 1,428 patients from a previously published randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation were analyzed to identify differences in umbilical cord blood acid-base measurements associated with the elective use of vacuum extraction (patients with duration of second stage of labor 60 min or less) and also in the presence of suspected fetal distress during the second stage of labor. When used electively, vacuum extraction was associated with lower pH (in both umbilical cord artery and vein), lower venous base excess, and higher venous carbon dioxide tension (PCO2), as compared to normal spontaneous vaginal delivery. After correcting for duration of second stage of labor, elective vacuum delivery was significantly associated only with a decrease in cord venous pH and increase in venous PCO2. However, these cord blood acid-base changes were not accompanied by any differences in perinatal morbidity and mortality or in the number of neonates born with acidemia (cord arterial pH < 7.15 or < 7.10). In cases of suspected fetal distress, the use of vacuum extraction was not associated with any detectable cord blood acid-base changes as compared to normal spontaneous vaginal delivery. These data support the continued use of vacuum extraction, especially in cases of suspected fetal distress during the second stage of labor.

Acid-Base Imbalance↗