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Fraune, Ariane Seifert) - One of the best experts on this subject based on the ideXlab platform.

  • Phonographic and echocardiographic monitoring to evaluate cardiac Murmurs in horses
    2010
    Co-Authors: Fraune, Ariane Seifert)
    Abstract:

    In der vorliegenden Studie wurden 28 Pferde unterschiedlicher Rassen im Stand der Ruhe einer auskultatorischen, einer digital-phonokardiographischen und einer echokardiographischen Untersuchung unterzogen. Nach der auskultatorischen Untersuchung konnten die 28 Pferde in vier Gruppen eingeteilt werden. Der ersten Gruppe war lediglich ein herzgesunder Proband zuzuordnen. Dieser Proband diente der Darstellung eines Phonokardiogramms mit dem Meditron Analyser 4.0 (der Firma Welch Allyn) ohne Herzgeräusch. Die zweite Gruppe umfasste Patienten mit diastolischen Herzgeräuschen (n = 10). Die dritte Gruppe rekrutierte sich aus Pferden mit systolischen Herzgeräuschen (n = 12). Pferde mit diastolischen und zugleich auch systolischen Herzgeräuschen waren in der vierten Gruppe zusammengefasst (n = 5). Zwei Pferde aus der zweiten Gruppe und drei Pferde aus der dritten Gruppe wiesen im Phonokardiogramm besondere Befunde auf, durch die sie sich von den anderen Tieren aus der jeweiligen Gruppe abgrenzten. Diese fünf Tiere erhielten in Einzelfalldarstellungen zusätzlich eine gesonderte Betrachtung (diastolisches Herzgeräusch (HG) mit stärkerer Variation der Intensität, spindelförmiges HG im AV-Block zweiten Grades bei sonst praesystolischem HG, funktionelles HG neben einem systolischen Regurgitationsgeräusch, Geräuschvariationen beim Vorhofflimmern, durch eine Fallotsche Tetralogie verursachte HG). Die echokardiographische Untersuchung diente dazu, den „Ist“-Zustand des Herzens zu evaluieren und umfasste Standardschnittbilder im B-Mode, Kontraktilitätsmessungen im M Mode und Doppleruntersuchungen. Hierbei wurden zum einen die Schließfähigkeit der Herzklappen mit dem Farbdoppler und zum anderen die an den insuffizienten Herzklappen befindlichen Rückflussgeschwindigkeiten mit dem CW-Doppler gemessen. Mit Hilfe der Echokardiographie ließen sich in der zweiten Gruppe fünf Tiere mit hgr. Aorten-klappeninsuffizienz (AVI), vier Pferde mit mgr. - hgr. AVI und ein Proband mit einer ggr. AVI diagnostizieren. Die Gruppe der Tiere mit den systolischen HG setzte sich aus folgenden Klappenerkrankungen zusammen: fünf mgr. Mitralklappeninsuffizienzen (MVI), eine ggr. - mgr. MVI, vier Pferde mit ggr., mgr., ggr. - mgr. bzw. mgr. - hgr. Trikuspidalklap-peninsuffizienz (TVI) bei zusätzlicher Lungenerkrankung (Lungenabszess, COB und zwei Tiere mit einer interstitiellen Pneumopathie), ein Pferd mit einer mgr. - hgr. TVI und einer hgr. MVI. Ein Fohlen war gekennzeichnet durch die echokardiographischen Befunde einer Fallotschen Tetralogie. Alle Pferde wurden einer phonokardiographischen Untersuchung unterzogen. Der Meditron Analyser ermöglicht das simultane Aufzeichnen von EKG und PKG. Dabei erfolgten bei jedem Patienten Aufzeichnungen von der linken Seite an den Puncta maxima der Mitralklappe, der Aortenklappe und der Pulmonalklappe sowie von der rechten Seite an der Trikuspidalklappe. Die objektiv dargestellten Herzgeräusche wurden mit Hilfe der visuellen Mustererkennung ausgewertet. Dabei wurden folgende Kriterien beurteilt: die Puncta maxima, die Frequenz, die Herzzyklusphase, die Charakteristik und die Intensität des Herzgeräusches. Die Intensität des Herzgeräusches wurde anhand der Amplitude semiquantitativ bestimmt. Bei deskriptiver Vorgehensweise war es Ziel der Studie, die Aussagekraft und die Nützlichkeit der digitalen Phonokardiographie zu untersuchen. Die Auskultation besitzt einen hohen Stellenwert in der Herzdiagnostik, deren Nutzen durch die Phonokardiographie ergänzt wer-den kann. Es wurden die Einflussfaktoren diskutiert und beurteilt, die sich auf die Darstellung der Herzgeräusche auswirken. Besonderes Augenmerk galt der auskultierten Intensität und der phonokardiographierten Amplitude der Herzgeräusche in Relation zur Schwere der Herzklappenerkrankung. Dabei konnte festgestellt werden, dass die Intensität und die Amplitude den Grad der Klappenerkrankung nicht immer widerspiegeln. Es wurde zudem deutlich, dass die Herzgeräusche mit dem Blutstrom fortgetragen werden. Daraus folgt, dass die Puncta maxima nicht als fixe Punkte anzusehen sind, sondern dass man zutreffender von Auskultationsarealen sprechen sollte. Auch müssen die HG einer insuffizienten Klappe nicht unbedingt am lautesten über dieser Klappe zu auskultieren sein.In this study, 28 horses of different breeds were examined at rest using auscultation, digital phonocardiography and echocardiography. After the auscultatory examination, it was possible to classify the 28 horses in four groups. The first group only contained one healthy test sub-ject. This animal was used to prepare a phonocardiogram without any cardiac Murmurs with the Welch Allyn Meditron Analyser 4.0. The second group consisted of patients with diastolic Murmurs (n = 10). The third group was made up of horses with systolic Murmurs (n = 12). Horses with both diastolic and systolic Murmurs were put into a fourth group (n = 5). Two horses from the second group and three horses from the third group displayed special characteristics in their phonocardiograms that set them apart from the other test subjects in their respective groups. Those five animals were discussed in more detail in individual case studies (diastolic Murmur with a greater variation in intensity, a spindle-shaped Murmur of grade 2 intensity in the atrioventricular block with otherwise Presystolic Murmur, functional Murmur in addition to systolic regurgitant Murmur, Murmur sound variations with atrial fib-rillation, cardiac Murmurs due to a tetralogy of Fallot). The echocardiographic examination was used to assess the actual state of the heart and in-cluded standard section B-mode images, M-mode measurements of contractility and Doppler ultrasound. The latter was employed to, on the one hand, evaluate cardiac valve function in colour and, on the other hand, measure the speed of regurgitation on the insufficient cardiac valves using CW-Doppler ultrasound. Five horses from the second group were diagnosed with severe aortic insufficiency using echocardiography. Four horses from the same group were diagnosed with moderate-to-severe and one with mild aortic insufficiency. The group with systolic Murmurs consisted of animals with the following valve insufficiencies: five moderate and one mild-to-moderate mitral in-sufficiencies, four horses with mild, moderate, mild-to-moderate or moderate-to-severe tri-cuspid insufficiencies with additional pulmonary disease (pulmonary abscess, COB and two horses with interstitial pneumopathy), one horse with moderate-to-severe tricuspid insuffi-ciency and severe mitral insufficiency. One foal displayed the characteristic abnormalities of a tetralogy of Fallot. All horses also underwent a phonocardiographic examination. The Meditron Analyser permits the simultaneous recording of an ECG and a PCG. For each patient, recordings were taken from the left-hand side on the auscultation points of the mitral valve, the aortic valve and the pulmonary valve and from the right-hand side on the tricuspid valve. The cardiac Murmurs were assessed visually according to their respective patterns using the following criteria - auscultation points, frequency, phase of the cardiac cycle and characteristics and intensity of the cardiac Murmurs. The intensity of the Murmurs was determined semi-quantitatively on the basis of the amplitude. Using a descriptive approach, it was the objective of this study to assess the validity and use-fulness of digital phonocardiography. Auscultation plays an important role in cardiac diag-nostics and phonocardiography can serve as a useful addition. In this study I discussed and evaluated factors that influence the representation of cardiac Murmurs. A special focus was on the auscultated intensity and on the phonocardiographic amplitude of the cardiac Murmurs vis-à-vis the severity of valvular insufficiency. In this connection I found that intensity and amplitude do not always reflect the severity of the condition. In addition, it became clear that cardiac Murmurs are carried away with the flow of blood. This means that the auscultation points are not to be regarded as fixed points, but that one should more correctly speak of aus-cultation areas. Moreover, cardiac Murmurs resulting from an insufficient valve are not neces-sarily heard the loudest over this valve

Harry T. Harper - One of the best experts on this subject based on the ideXlab platform.

  • FUNCTIONAL MITRAL STENOSIS*
    2016
    Co-Authors: Meinhard Robinow, Harry T. Harper
    Abstract:

    A sign commonly considered characteristic of mitral stenosis is a mid-diastolic Murmur at the cardiac apex. The Murmur is usually low-pitched, rumbling, and not very loud. It is separated from the second heart sound by a definite time interval. It may be short in early diastole or may extend throughout diastole. In the latter case it decreases at first in intensity to increase again toward the end of diastole (Presystolic Murmur). It is usually well localized, near the apex, less commonly at the mitral valve area. Murmurs indistinguishable from the diastolic Murmur of mitral stenosis have been described in a variety of other conditions: Aortic regurgitation (Austin Flint Murmur),1 adhesive pericarditis,2 various types of chronic anemia with heart enlargement,3 and rheumatic heart disease in young people without the presence of organic mitral stenosis.4'5 We have observed this Murmur in young patients suffering from acute nephritis with hypertension and cardiac dilatation, disappearing when blood pressure and heart size returned to normal. Recent studies on the hear

Oki T - One of the best experts on this subject based on the ideXlab platform.

  • Phonocardiographic and Doppler echocardiographic study on the mechanism of the Presystolic Murmur in mitral stenosis, especially the relationship to mitral inflow dynamics
    Journal of cardiology, 1994
    Co-Authors: Tabata T, Nobuo Fukuda, Arata Iuchi, Oki T
    Abstract:

    The cause of the "Presystolic Murmur" in mitral stenosis was investigated by phonocardiography and continuous wave Doppler echocardiography in 31 patients with mitral stenosis and sinus rhythm classified into two groups: 18 patients with and 13 without "Presystolic Murmur". 1. The "Presystolic Murmur" group demonstrated high frequency vibrations preceding the first heart sound coinciding with the initial low frequency component of the first heart sound recorded at the apex in both groups. 2. There were two types of "Presystolic Murmur": The first type observed in three of the 18 patients occurred during the accelerated phase of the atrial (A) wave of mitral inflow signals and lasted until the first heart sound. The A wave velocity in mitral inflow signals was high at the onset and peak, and rapidly decreased after the peak. The second type observed in 15 patients occurred during the decelerated phase of the A wave and lasted until the first heart sound. The A wave velocity in mitral inflow signals was low at the onset, but high at the peak and rapidly decreased after the peak. 3. The mitral orifice area tended to be smaller in all patients with "Presystolic Murmur". The peak flow velocity, deceleration rate of the A wave, and maximal pressure gradient across the mitral valve during atrial contraction were significantly increased in all patients with "Presystolic Murmur". 4. Five patients with newly developed "Presystolic Murmur" after amyl nitrite inhalation had an increased initial low frequency component of the first heart sound coinciding with the latter half of "Presystolic Murmur". The rate of increase in the peak flow velocity and the deceleration rate of the A wave were significantly larger and the maximal atrioventricular pressure gradient during atrial contraction tended to be larger in these five patients than those in five who did not develop "Presystolic Murmur". 5. The peak flow velocity, deceleration rate of the A wave and the maximal atrioventricular pressure gradient during atrial contraction had increased 1 year later compared with those immediately after cardioversion of atrial fibrillation, and newly developed "Presystolic Murmur" appeared according to the recovery of left atrial mechanical function. These results suggest that the latter half of "Presystolic Murmur" originates from augmentation and prolongation of the initial low frequency component of the first heart sound up to the audible range caused by the sudden deceleration of mitral inflow velocity due to left ventricular contraction, and that the early half of "Presystolic Murmur" is the atriosystolic Murmur produced by the increase in mitral inflow velocity during atrial contraction.

Junichi Yoshikawa - One of the best experts on this subject based on the ideXlab platform.

  • Long-surviving patient with isolated absent pulmonary valve syndrome: a case report
    Journal of cardiology, 2005
    Co-Authors: Kazue Okajima, Yoshio Kawase, Takao Hasegawa, Katsunori Hato, Masaki Nishimoto, Junichi Yoshikawa
    Abstract:

    A 79-year-old woman was admitted for exertional dyspnea in September 2001. She had begun to experience unusual fatigue from the age of 40 years. Cardiac examination revealed a single S2, Levine grade II/VI Presystolic Murmur in the 5th left sternal border, and a right parasternal impulse. Echocardiography showed dilated right chambers and absence of pulmonary valve leaflets. Doppler echocardiography at the pulmonary annulus revealed a 'to and fro' pattern. Cardiac catheterization indicated the same diastolic pressures in the pulmonary artery and right ventricle. The diagnosis was absent pulmonary valve syndrome. Administration of a diuretic agent resulted in almost immediate improvement of symptoms. Absent pulmonary valve syndrome, generally associated with tetralogy of Fallot, often causes severe respiratory failure or right heart failure during infancy. A case of such long survival without associated cardiac anomalies is very rare.

Meinhard Robinow - One of the best experts on this subject based on the ideXlab platform.

  • FUNCTIONAL MITRAL STENOSIS*
    2016
    Co-Authors: Meinhard Robinow, Harry T. Harper
    Abstract:

    A sign commonly considered characteristic of mitral stenosis is a mid-diastolic Murmur at the cardiac apex. The Murmur is usually low-pitched, rumbling, and not very loud. It is separated from the second heart sound by a definite time interval. It may be short in early diastole or may extend throughout diastole. In the latter case it decreases at first in intensity to increase again toward the end of diastole (Presystolic Murmur). It is usually well localized, near the apex, less commonly at the mitral valve area. Murmurs indistinguishable from the diastolic Murmur of mitral stenosis have been described in a variety of other conditions: Aortic regurgitation (Austin Flint Murmur),1 adhesive pericarditis,2 various types of chronic anemia with heart enlargement,3 and rheumatic heart disease in young people without the presence of organic mitral stenosis.4'5 We have observed this Murmur in young patients suffering from acute nephritis with hypertension and cardiac dilatation, disappearing when blood pressure and heart size returned to normal. Recent studies on the hear