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At least 19 recordsLinked to original sources
PubMed1986

[Power spectrum of heart murmurs: special reference to mitral regurgitant murmurs].

Heart murmurs, especially the mitral regurgitant murmurs of 40 patients were analyzed using the fast Fourier transformation technique. 1. Three types of frequency spectral pattern of mitral regurgitation (MR) were demonstrated: A) broad, spanning 100 to 500 Hz, B) narrow, characterized by one giant peak, and C) two peaks. The reason for these patterns was not clear, but they may be related to various hemodynamic events. 2. The mean frequency (f) in MR was 295 +/- 38 Hz and it increased in proportion to the regurgitant grade: e.g., Sellers II, 258 +/- 27 Hz; Sellers III, 294 +/- 23 Hz; and Sellers IV, 311 +/- 65 Hz. The accumulated percentage of the 200-400 Hz component decreased, while that of the 400-600 Hz component increased. 3. The f in MR of various etiologies were as follows: It was higher in ruptured chordae tendineae, rheumatic cases and mitral valve prolapse syndrome, but was lower in papillary muscle dysfunction and dilated cardiomyopathy. In the latter two, the percentage of the 0-200 Hz component was greater than in other disorders. The degree of left ventricular dysfunction and of myocardial injury may be responsible for the changes in the propagation properties. In ventricular septal defect and aortic stenosis, the f was 306 +/- 12 Hz and 230 +/- 40 Hz, respectively. The frequency spectrum of the latter was lower than that of MR, which may be derived from the difference between ejection and regurgitant murmurs; whereas, that of ventricular septal defect was similar to that of rheumatic MR. 4. The relation between the frequency spectrum and the phase of systole was studied. In dilated cardiomyopathy and papillary muscle dysfunction, the f of each phase increased in late systole; whereas, the maximum f was in mid-systole in other disorders. 5. Administration of amyl nitrite resulted in a decreased f, an increased percentage of the 0-200 Hz component, and a decreased 400-600 Hz component. The spectral distribution shifted to the lower frequency region. Results of this study suggested that significant information can be obtained from the frequency analysis of heart murmurs.

Adolescent↗
PubMed2006

Feature extraction for systolic heart murmur classification.

Heart murmurs are often the first signs of pathological changes of the heart valves, and they are usually found during auscultation in the primary health care. Distinguishing a pathological murmur from a physiological murmur is however difficult, why an "intelligent stethoscope" with decision support abilities would be of great value. Phonocardiographic signals were acquired from 36 patients with aortic valve stenosis, mitral insufficiency or physiological murmurs, and the data were analyzed with the aim to find a suitable feature subset for automatic classification of heart murmurs. Techniques such as Shannon energy, wavelets, fractal dimensions and recurrence quantification analysis were used to extract 207 features. 157 of these features have not previously been used in heart murmur classification. A multi-domain subset consisting of 14, both old and new, features was derived using Pudil's sequential floating forward selection (SFFS) method. This subset was compared with several single domain feature sets. Using neural network classification, the selected multi-domain subset gave the best results; 86% correct classifications compared to 68% for the first runner-up. In conclusion, the derived feature set was superior to the comparative sets, and seems rather robust to noisy data.

Aged↗
PubMed2004

[Echocardiographic abnormalities in infants with heart murmur].

OBJECTIVES: Congenital heart diseases are very serious problem of current perinatology. Early detection of congenital heart diseases and new possibilities of their treatment have decreased mortality rate in neonates. THE AIM OF THE STUDY: Was to present the reasons of the heart murmurs found in newborns, based on postnatal echocardiography. MATERIAL AND METHODS: The study group consisted of 107 neonates born in The Obstetrics and Gynaecology Clinic of Medical University in Warsaw in the period from 1st October, 2001 until 30th September, 2002, found to have murmurs during the observation in The Neonatology Department. RESULTS: Heart murmurs were detected in 107 infants out of 1291 born in The Clinic in this period. Out of the study group, echocardiography results were normal in fourteen children, and in ninety-three patients the echocardiography revealed one of the following abnormalities: persistent foramen ovale (FO), persistent ductus arteriosus (PDA), ventricular septum defect (VSD), insufficiency of tricuspid valve (IT) and others. CONCLUSIONS: The most frequently observed abnormality in echocardiography in infants with heart murmur was persistent foramen ovale. The rate of heart abnormalities was the highest in infants with birth weight below 1500 G.

Ductus Arteriosus, Patent↗
PubMed2005

[Referral practice and clinical assessment of heart murmurs in children].

BACKGROUND: Heart murmurs in infants and children are common, and in most cases these are physiological murmurs. In a few cases they represent congenital heart disease; it is important to detect those few children by referral to paediatric cardiologists. MATERIAL: 220 consecutive children with heart murmur were investigated prospectively as outpatients in the Children's clinic, Haukeland University Hospital from January through December 2001. Referrals were from general practitioners (n = 157), paediatricians or residents at the Children's clinic (n = 51), and from one community-based paediatrician (n = 12). The purpose was to assess the referrals for completeness and judgment before cardiological assessment. Our second goal was to see if the paediatric cardiologist could differentiate between innocent and pathological murmurs by history and clinical assessment only. RESULTS: 22 (10%) of the referred patients had congenital heart defects. They had been through a complete clinical assessment by 38.9% of the general practitioners and 83.3% by the community-based paediatrician (p = 0.0001). A conclusion regarding diagnosis before hospital evaluation was reached in only 17.8% of the patients by the general practitioners and in 50% by the paediatricians (p < 0.0001). The diagnostic accuracy of the clinical evaluation by the paediatric cardiologists had a sensitivity of 81.5%, specificity of 98.5%, positive and negative predictive values of 88 and 97.5%, respectively. Two patients with significant atrial septum defect would have been missed by clinical assessment only. INTERPRETATION: Skills in clinical assessment of heart murmurs in infants and children can be improved among general practitioners and paediatricians in training. Paediatric cardiologists can differentiate between physiological and pathologic murmurs by clinical evaluation only.

Adolescent↗
PubMed1990

Initial evaluation of heart murmurs: are laboratory tests necessary?

Heart murmurs, most of them innocent, are the most common reason for referrals to a pediatric cardiologist. In the evaluation of murmurs, the electrocardiogram and echocardiogram are often included. The purpose of this study was to determine the utility of these examinations in the initial assessment of heart murmurs in children and adolescents. In a prospective series of 161 patients, the clinical diagnosis of heart murmurs by a pediatric cardiologist was compared with that obtained after electrocardiogram and echocardiogram (two-dimensional, M-mode, Doppler, and color-Doppler). On the basis of the clinical diagnosis the patients were classified as having "innocent murmur," "pathologic murmur," or "possible pathologic murmur." A total of 161 patients (51% males), aged 1 month to 17 years (median 3.2 years), were studied. After electrocardiogram, no diagnosis was changed. After echocardiogram, the clinical diagnosis of innocent murmur in 109 patients changed in 2 to pathologic (small ventricular septal defect 1, small atrial septal defect 1); pathologic murmur in 46 changed to innocent in 3 and possible pathologic in 2; and possible pathologic in 6 changed to innocent in 3 and to pathologic in 2. The clinical examination by an experienced pediatric cardiologist is an accurate means of assessing newly referred patients with murmurs. The clinical examination had a sensitivity of 96%, specificity of 95%, positive predictive value of 88%, and negative predictive value of 98%. The electrocardiogram, unlikely to disclose any unsuspected heart disease, may assist in reaching the lesion-specific diagnosis when there is underlying pathology. Echocardiography, although diagnostic when heart disease is suspected, is unnecessary in pediatric patients with clinically diagnosed innocent heart murmurs.

Adolescent↗
PubMed2006

[Heart murmur--auscultation or echocardiography in the diagnostic assessment of congenital or valvular heart disease?].

The incidence of patients with degenerative valvular but also of patients with congenital heart disease surviving until adulthood or even old age will increase in the next decades. Auscultation with the stethoscope remains an important diagnostic means in the detection and treatment of heart disease. Heart murmurs (especially systolic heart murmurs) are extremely common. There are helpful clues to differentiate heart murmurs. It can occasionally be relatively simple to differentiate a systolic murmur due to valvular heart disease from an innocent, ejection murmur; however, there are important limitations of auscultation. Overall, auscultation and clinical examination alone do not suffice to correctly diagnose and treat patients with heart failure or a murmur Clinically significant aortic stenosis, aortic regurgitation and mitral regurgitation as well as hypertrophic cardiomyopathy are not uncommonly missed or misinterpreted. An echocardiographic exam is mandatory in all patients with more than a soft systolic murmur, any diastolic murmur, cardiac symptoms and/or ECG changes.

Auscultation↗
PubMed2005

Evaluation of a novel method for grading heart murmur intensity.

OBJECTIVE: To determine if heart murmur intensity grading performance can be improved using the heart sounds as an internal reference. METHODS: Single-blind controlled trial of 100 medical students, residents, and pediatric attending physicians at a children's hospital. Groups of 1 to 3 participants were alternately assigned to intervention and control groups, reported their method of grading heart murmur intensity, and then graded the intensity of a random sample of 20 recorded murmurs on a 6-point scale. Before rating another random sample of 20 murmurs, the intervention group was taught a system that uses the heart sounds as an internal reference. Primary outcomes were change in accuracy (percentage correct), interrater agreement (kappa), and consistency (kappa). Subgroup analyses were performed by training level and heart murmur grade. RESULTS: Grading accuracy improved more in the intervention group than the control group (Delta improvement, 5%; 95% confidence interval [CI], -0.1%-10.0%]). This was most pronounced among attending physicians (Delta improvement, 11%; 95% CI, 0.4%-22%) and students (Delta improvement, 12%; 95% CI, 3%-20%) and for grade 2 murmurs (Delta improvement, 20%; 95% CI, 10%-31%). Relatively greater improvements in consistency were observed after the intervention for attending physicians (Delta improvement, 0.17; 95% CI, 0.01-0.32) and grades 2 (Delta improvement, 0.22; 95% CI, 0.09-0.36) and 3 murmurs (Delta improvement, 0.16; 95% CI, 0.05-0.28). CONCLUSIONS: A system that uses the heart sounds as an internal reference for grading heart murmur intensity quickly improves accuracy and consistency for some providers and specific murmurs.

Clinical Competence↗
PubMed2005

Heart murmur and anaemia in the pediatric population.

Innocent heart murmurs are hearth murmurs that occur in patients with a normal heart structure. They do not represent a disease of the heart and vascular system, and should not be treated as such. Iron-deficiency anaemia often causes, along with other symptoms, systolic heart murmurs and tachycardia. It appears in children of all ages representing a most common haematological paediatric disease. To establish the influence of iron-deficiency anaemia on genesis of innocent murmurs and to compare auscultatory and phono-electrocardiographic findings in patients with anaemia and heart murmurs before and after iron therapy. The study includes 120 patients with innocent heart murmurs that have been auscultated at cardio-rheumatic outpatient department of Pediatric Clinic of the Clinical Center of the University of Sarajevo, during the period from 01/01/2004 to 31/12/2004. Further diagnostic procedure, i.e. laboratory tests, diagnosed iron-deficiency anaemia in 30/120 patients. These patients have been followed in this study. 22/30 patients had systolic murmur I/II intensity of Levin scale; 8/30 patients had II/VI systolic murmurs of intensity by Levin. The highest number of examinees had 0-1 years of age, and in this group the number of boys was higher than the number of girls (M: F = 12:4). During the auscultatory and phono-ECG examinations of murmurs, 6 patients had haemoglobin values less than 95 g/l, which corresponds to an average and severe type of anaemia. 24 patients had haemoglobin values between 95 and 110 g/l, which corresponds to benign type of anaemia. The most numerous were patients aged between 0 - 1 year (3 patients with hemoglobin value Hb < 95 g/l, 13 patients with hemoglobin value Hb 95-110 g/l). All patients were treated with iron medicaments. After three months, clinical and laboratory re-evaluation was performed and it has demonstrated that after iron therapy 24 patients had level of a haemoglobin Hb >110 g/l and 6 patients had haemoglobin levels between 95 and 110 g/l. By auscultatory and phono-ECG examinations, murmurs of a level of intensity I/II was registered in only one child, while in the other 29 patients there were not any registered heart murmurs. Diagnosis of anaemia in the paediatric population group delays definitive diagnosis of heart murmurs. Innocent murmurs in children with sideropenic anaemia occur as its consequence. After adequately conducted iron therapy, i.e. cured anaemia, heart murmurs were not auscultated.

Adolescent↗
PubMed2005

The patient with a heart murmur: evaluation, assessment and dental considerations.

BACKGROUND: Heart murmurs, a common finding in dental patients, are of major concern to dental professionals because certain dental procedures occasionally can induce severe cardiovascular complications. Murmurs may indicate existing heart disease that is a risk factor for infective endocarditis following a dental procedure, as well as more severe heart conditions such as congenital heart disease, atrial fibrillation or congestive heart failure. TYPES OF STUDIES REVIEWED: This review article is based on data published in peer-reviewed journals, including practice guidelines published by major dental and medical professional organizations. RESULTS: Echocardiography is the primary means of evaluating heart murmurs, and all dental professionals should become familiar with major aspects of an echocardiogram. Understanding the medical evaluation and assessment of a heart murmur fosters better communication with other health care professionals and results in improved patient care. CLINICAL IMPLICATIONS: Beyond the need to administer antibiotic prophylaxis, the dentist also needs to address the underlying causes of a patient's heart murmur. By providing dental care to such patients, oral health care providers become part of the patient's overall health care team.

Antibiotic Prophylaxis↗
PubMed2001

Heart murmurs: are older male dental patients aware of their existence?

BACKGROUND: The American Heart Association recommends that patients with certain abnormal and prosthetic heart valves receive antibiotic prophylaxis before undergoing invasive dental treatment, owing to the risk of bacterial endocarditis, or BE. However, it is not known how many patients are aware that they have such conditions and understand such recommendations. METHODS: The authors conducted a study to determine how many male users of three U.S. Department of Veterans' Affairs ambulatory medical care centers denied having a heart murmur, even though a murmur was noted in their medical record. The authors asked 637 potential subjects a series of questions to identify those who had a heart murmur that might place them at risk of developing BE. The authors then reviewed each subject's medical records for documentation of a heart murmur. RESULTS: Four hundred ninety-seven dentate men (mean age: 61.0 years) denied having a heart murmur. Seventy (14.1 percent) of these men had documentation of a heart murmur in their medical records, and 13 (2.6 percent) had murmurs that were likely to be pathological. The failure to accurately report having a heart murmur and having a potentially pathological heart murmur were positively related to age (P = .001). Failure to accurately report having a heart murmur also was related to lower educational levels. CONCLUSIONS: These results indicate that a substantially larger number of older men than younger men were unaware that they had a heart murmur. Since some of these murmurs necessitate administration of antibiotic prophylaxis before dental procedures, this failure to communicate their correct medical status may put them at risk of developing BE. CLINICAL IMPLICATIONS: Dental health care providers should be aware that patient self-report may not be a reliable indicator of cardiac status, particularly in older patients.

Age Factors↗
PubMed1989

Continuous spectral analysis of heart murmurs for evaluating stenotic cardiac lesions.

Severity of stenotic heart lesions affects timing, quality and pitch of associated heart murmurs. This quantitative study investigated the relation between instantaneous sound frequencies contained in heart murmurs and magnitudes of Doppler jet velocities measured distal to associated obstructions. Heart murmurs were recorded from 18 patients, ages 1 day to 23 years, with 21 separate murmurs resulting from abnormal valves (18 studies) or left-to-right shunts (3 studies). Recorded murmurs were digitized and divided into 12.3-ms time segments for computer frequency analysis using the maximum entropy method. Murmur spectra were plotted in gray scale against time. All murmurs contained dominant frequencies that varied with time. Dominant murmur frequencies and associated Doppler jet velocities at equivalent points in time were measured at 50-ms intervals. For 88 points analyzed, instantaneous dominant frequencies ranged from 130 to 410 Hz (mean +/- standard deviation 282 +/- 70 Hz) and instantaneous jet velocities ranged from 110 to 460 cm/s (290 +/- 80 cm/s). For the 21 murmurs studied, peak murmur frequencies ranged from 200 to 410 Hz (308 +/- 70 Hz) and peak jet velocities ranged from 165 to 460 cm/s (320 +/- 78 cm/s). Instantaneous dominant frequency correlated to instantaneous jet velocity (r = 0.85) and peak dominant frequency correlated to peak jet velocity (r = 0.89). This in vivo study demonstrates that dominant frequencies contained in heart murmurs are related to instantaneous jet velocities distal to associated obstructions.

Adult↗
PubMed2006

[Accurate assessment of heart murmurs in children: thorough medical history and physical examination required].

4 children, boys aged 12, 5, 1.5 and 11 years, had a heart murmur. The 12-year-old boy could also not finish a football match and appeared to have atrioseptal defects (ASD). The 1.5-year-old boy had pulmonary symptoms that were not responsive to asthma medication; he also had ASD. The 11-year-old boy had had chest pain and pressure following exertion for 2 years; he appeared to have an aortic stenosis. Symptoms disappeared in all 3 patients after surgical correction. In the 5-year-old asymptomatic boy the murmur was deemed to be innocent following medical history and physical examination. Children frequently have heart murmurs. Most heart murmurs are innocent but some are caused by heart defects. Careful evaluation of the medical history and physical examination are critical in the differentiation of innocent and pathological heart murmurs. Routine supplementary diagnostic tests in children with heart murmurs are of limited value and are often misleading. One should inquire about specific and nonspecific symptoms and also perform systematic inspection, palpation and auscultation to identify any characteristics that suggest a heart murmur caused by a heart defect.

Aortic Valve Stenosis↗
PubMed1992

Intracardiac needle in a man with self-injurious behaviour presenting with only a heart murmur.

Symptoms of a heart murmur in a 48-year-old male schizophrenic patient with self-injurious behaviour were investigated. Immediately noticeable were multiple scars on his hands. Clinical evidence of subcutaneous needles and aortic regurgitation was found. Echocardiography revealed a linear metallic foreign body across the interventricular septum. He underwent surgery and via a right atriotomy, a needle from the same location was removed.

Echocardiography↗