Heart Murmur in Neonates: How Often Is It Caused by Congenital Heart Disease

Abstract Objective: Congenital heart disease (CHD) is the most common form of cardiovascular diseases in children. This study was performed from September 2006 to August 2007 in Ardebil, Westnorthern Iran. The aim was to determine the prevalence of heart murmur in newborns and its correlation with CHD. Methods: In a 1-year cross sectional descriptive-analytic study, 2928 newborns were screened for heart murmur during routine neonatal physical examination. All babies with murmur underwent echocardiography. Findings: Murmur was detected in 91 (3.1%) neonates, of whom 47 (51.6%) had a congenital heart disease. The most common (17.6%) abnormality was ventricular septal defect. Patent ductus arteriosus was found in 10 (11%) patients. Conclusion: Remarkable high (round 50 %) rate of CDH in newborns presenting with heart murmur, urges to observe these neonates closely to establish the diagnosis of congenital heart disease and early referral to pediatric cardiologist

Systolic ejection murmurs and the left ventricular outflow tract in boxer dogs

Turbulence of various genesis in the left ventricular outflow tract (LVOT) causes systolic ejection murmurs. The prevalence of murmurs in adult boxer dogs is 50-80%, the majority of which are of low intensity. Some of the murmurs are caused by aortic stenosis (AS), while the origin of the others is unclear. The aim of this thesis was to study the physiology and clinical evaluation of systolic ejection murmurs and their relation to the development of the LVOT in boxers with and without AS. Growing and adult boxer dogs were examined by the standard methods cardiac auscultation, ECG, phonocardiography and echocardiography. Additionally, the complementary methods time-frequency and complexity analyses of heart murmurs and contrast echocardiography were evaluated. Studies on inter-observer variation in cardiac auscultation proved the importance of experience in detection and grading of low intensity ejection murmurs. Excitement of the dogs by exercise or noise stimulation (barking dog and squeaky toy) caused higher murmur grades, longer murmur duration and increased aortic flow velocities. No differences were found between diameters measured at different levels of the LVOT in growing boxers. Contrast echocardiography enhanced Doppler signals, but did not allow evaluation of myocardial blood flow. Using time-frequency analysis, duration of murmur frequency >200 Hz proved useful for differentiation between dogs with mild AS and dogs without. Combining assessment of murmur duration >200 Hz and complexity analysis using the correlation dimension (T2), a sensitivity of 94% and a specificity of 82% for differentiation between dogs with and without AS was achieved. The variability in presence and intensity of low intensity murmurs during growth was high. None of the young dogs developed AS, whereas 3 out of 16 individuals developed mild-moderate aortic insufficiency. Aortic or pulmonic flow velocities did not differ significantly between growing dogs with or without low intensity murmurs. In conclusion, the variability in presence and intensity of low intensity ejection murmurs in boxers is high during growth with no obvious progression. Both in young and adult boxers the murmur grade increased during excitement, which may be due to rapid flow in a comparatively small LVOT that has been suggested for the boxer breed. Experience is important in cardiac auscultation of low intensity murmurs. Therefore, assessment of murmur duration > 200 Hz combined with T2 analysis may be a useful complementary method for diagnosis of cardiovascular function in dogs

Cardiac Auscultatory Skills of Academic Family Physicians: Strength of Association with an Academic Pediatric Cardiologist

Aim. Heart murmur is common in children, and it is one of the main reasons for referral among children in primary care. The aim of this study is to evaluate agreement and consistency of normal, innocent, and pathologic murmur decision between academic family physicians and academic pediatric cardiologist. Methods. Seven hundred fifteen primary school children were examined by family physicians and paediatric cardiologist. Auscultatory examination was performed. Intensity, frequency, duration, quality, location, and radiation of the murmur were described if present. Agreement of normal, innocent, and pathologic murmur classification decision between family physician and paediatric cardiologist was analyzed by using kappa statistic. Results. Normal, innocent and pathologic murmurs were reported for 419, 228, and 54 children in family physicians' reports, respectively. Paediatric cardiologist agreed on 383 (91.4%) children as normal, 191 (83.7%) children having innocent murmur, and 19 (35.2%) children having pathologic murmur among family physician's reports. There was good consistency between family physicians and paediatric cardiologist (κ value = 0.679, 95% CI 0.630–0.727, P < .001). They agreed on the majority of normal and innocent murmur decisions. However family physicians reported pathologic murmur more frequently. Conclusion. Cardiac auscultatory skills of academic family physicians may be concordant with paediatric cardiologist

Extraction and Assessment of Diagnosis-Relevant Features for Heart Murmur Classification [post-print]

This paper presents a heart murmur detection and multi-class classification approach via machine learning. We extracted heart sound and murmur features that are of diagnostic importance and developed additional 16 features that are not perceivable by human ears but are valuable to improve murmur classification accuracy. We examined and compared the classification performance of supervised machine learning with k-nearest neighbor (KNN) and support vector machine (SVM) algorithms. We put together a test repertoire having more than 450 heart sound and murmur episodes to evaluate the performance of murmur classification using cross-validation of 80–20 and 90–10 splits. As clearly demonstrated in our evaluation, the specific set of features chosen in our study resulted in accurate classification consistently exceeding 90% for both classifiers

Evaluation of Heart Murmur Etiology in Neonates at Neonatology ward in Imam Khomaini and Alavi Hospitals from mehr 1385 Until mehr 1386

Introduction : Congenital heart disease is the most common form of cardiovascular disease in children. In attention to importance of this anomaly and no previous data about prevalence of CHD in this area, the study was performed in Ardebil in the period from mehr 1385 until mehr 1386. The aim of this study was to present the reasons of heart murmurs found in new borns based on postnatal echocardiography and to investigate the correlation between heart murmur and different factors associated with CHD. Material & Methods : A sectional descriptive-analytic study on 91 newborns admitted in the Imam Khomeini and Alavi Hospitals in the neonatology ward in the period from mehr 1385 until mehr 1386, found to have heart murmur during the clinical examination. The data and echocardiography results were extracted from files. Results : Echocardiography results was normal in 28 newborns (30.8%), and the others had CHD,the most frequently abnormality was VSD that was found in 15 cases(16.5%). TR was found in 13 patients(14.3%).Other findings were: PDA(5.5%), PS(5.5%), LVH(3.3%) , PDA and TR together (3.3%) , TGA ( 2.2%) , ASD (2.2%). 38 of cases who had CHD (41.8%) were female and 25(27.5%) were male .There was no history of CHD in sibling in the newborns.Using of folic Acid during prenatal period or first trimester of pregnancy by mothers was seen in 42 of cases (72.4%)who had CHD.7 newborns below 1500gr(53.8%) and 26 of cases (65%) with normal birth weight (2500-4000gr)had CHD. 59.3% of patents were first child. In half of cases heart murmur was detected at first day of life or the first week of life.There is a negative correlation between age of mother and CHD (sig=0.044<0.05) and there's no significant correlation between CHD and other factors. Conclusions : Innocent murmur was found in about one-third of newborns, and the others had CHD. The most frequently abnormality was VSD Echocardiogram is suitable for diagnosis of the abnormalities. The rate of CHD is higher in newborns that their mothers were older (sig=0.044)

Intracardiac Phonocardiography in Subaortic Stenosis

The purpose of this study is to explore the value of intracardiac sound recordings for the verification of subaortic stenosis. Intracardiac sound was measured in ten patients with subaortic obstructions. Seven had idiopathic hypertrophic subaortic stenosis, two had a subvalvular membrane, and one had a subvalvular tunnel. In each patient, a systolic murmur was recorded within the left ventricle distal to the obstruction. The murmur was of lower amplitude distal to the aortic valve, and it was of even lower amplitude or absent proximal to the obstruction. In the presence of entrapment, no intraventricular murmur occurred although an apparent subvalvular pressure gradient was observed. The identification and localization of the maximal intensity of a systolic murmur in the ventricular outflow tract may assist in the verification of a subvalvular obstruction and help distinguish between artifactual pressure gradients and gradients indicative of subvalvular stenosis

Management of incidentally detected heart murmurs in dogs and cats

A dog or a cat has an incidentally detected heart murmur if the murmur is an unexpected discovery during a veterinary consultation that was not initially focused on the cardiovascular system. This document presents approaches for managing dogs and cats that have incidentally-detected heart murmurs, with an emphasis on murmur characteristics, signalment profiling, and multifactorial decision-making to choose an optimal course for a given patient

A comparison of clinical paediatric murmur assessment with echocardiography

Objective: To compare the clinical acumen of paediatric cardiovascular examination between various hospital paediatrician grades. Design: Prospective data collection of clinical and echocardiography findings on paediatric echocardiography referrals. Setting and patients: All paediatric patients (birth - 14 years) referred for echocardiography, in a regional hospital catering for the island population of Malta. Echocardiography was carried out by three paediatricians with tertiary training in this technique. Main outcome measures: Pre-echocardiography clinical diagnoses were compared with echocardiography results according to grade of referring hospital doctor (ranging from houseman to consultant). Both normal and abnormal hearts at echocardiography were included. Results: Echocardiographers had the highest clinical accuracy and the highest attempts at reaching a clinical diagnosis. Accuracy and attempts at diagnosis decreased as doctor's hospital grade decreased, from consultant to houseman. Ventricular septal defect was the most easily diagnosed lesion. Atrial septal defect was often misdiagnosed as pulmonary stenosis.peer-reviewe