Primary cardiac tumours (PCT) are rare in the paediatric population. They can present in a variety of ways – from being asymptomatic, obstructive with heart failure, strokes, arrhythmias or sudden death. We present a 2-month-old child who was admitted because of heart failure from varying types of arrhythmias and was found on echocardiography to have a large left ventricular tumour. A high clinical suspicion in any infant or child who presents with an unexplained heart murmur, arrhythmias or congestive heart failure should prompt relevant investigations ruling out this entity.
Extrinsic pulmonary artery stenosis caused by anterior mediastinum teratoma presenting with an ejection systolic murmur is a rare phenomenon. Till date, 15 cases have been reported (inclusive of this case) in the English literatures. Herein we report a 20 year old female with extrinsic pulmonary artery stenosis because of compression by an anterior mediastinal teratoma with a loud ejection systolic murmur. The case report aims to highlight the awareness of such rare presentation of anterior mediastinal teratomas that may mimic congenital valvular heart diseases among clinicians.
Auscultation of the heart is accompanied by both electrical activity and sound. Heart auscultation provides clues to diagnose many cardiac abnormalities. Unfortunately, detection of relevant symptoms and diagnosis based on heart sound through a stethoscope is difficult. The reason GPs find this difficult is that the heart sounds are of short duration and separated from one another by less than 30 ms. In addition, the cost of false positives constitutes wasted time and emotional anxiety for both patient and GP. Many heart diseases cause changes in heart sound, waveform, and additional murmurs before other signs and symptoms appear. Heart-sound auscultation is the primary test conducted by GPs. These sounds are generated primarily by turbulent flow of blood in the heart. Analysis of heart sounds requires a quiet environment with minimum ambient noise. In order to address such issues, the technique of denoising and estimating the biomedical heart signal is proposed in this investigation. Normally, the performance of the filter naturally depends on prior information related to the statistical properties of the signal and the background noise. This paper proposes Kalman filtering for denoising statistical heart sound. The cycles of heart sounds are certain to follow first-order Gauss-Markov process. These cycles are observed with additional noise for the given measurement. The model is formulated into state-space form to enable use of a Kalman filter to estimate the clean cycles of heart sounds. The estimates obtained by Kalman filtering are optimal in mean squared sense.
Cardiovascular disease (CVD) is the leading cause of death worldwide, and due to the lack of early detection techniques, the incidence of CVD is increasing day by day. In order to address this limitation, a knowledge based system with embedded intelligent heart sound analyser (KBHSA) has been developed to diagnose cardiovascular disorders at early stages. The system analyses digitized heart sounds that are recorded from an electronic stethoscope using advanced digital signal processing and artificial intelligence techniques. KBHSA takes into account data including the patient's personal and past medical history, clinical examination, auscultation findings, chest x-ray and echocardiogram, and provides a list of diseases that it has diagnosed. The system can assist the general physician in making more accurate and reliable diagnosis under emergency conditions where expert cardiologists and advanced equipment are not readily available. To test the validity of the system, abnormal heart sound samples and medical data from 40 patients were recorded and analysed. The diagnoses made by the system were counter checked by four senior cardiologists in Malaysia. The results show that the findings of KBHSA coincide with those of cardiologists.
An 8-year-old spayed female Shih Tzu was referred to University Veterinary Hospital (UVH) with history of chronic coughing for more than a year duration. Dry, hacking cough was heard and bilateral wheezing lung sound was noted upon physical examination. Auscultation of heart revealed left apical systolic heart murmur Grade III/VI. A soft, intermittent swelling was observed at ventral neck, cranial to thoracic inlet (protruded upon expiration and collapsed upon inspiration). Thoracic radiography taken showed presence of apical radiolucency at cervical region and bronchial pattern at caudodorsal lungs with left atrium enlargement and right-sided heart enlargement. Echocardiographic examination revealed myxomatous mitral valve disease (MMVD) with mild regurgitation. Based on diagnostic imaging, this case was diagnosed as dynamic lung lobe herniation secondary to chronic coughing concurrent with myxomatous mitral valve disease. Other differential diagnosis that may lead to chronic cough such as of tracheal collapsed and bronchiectasis was not rule out.
A 19-year-old man presented with sudden onset of right eye ptosis, diplopia and giddiness. He had no previous medical illnesses with negative history of exertional dyspnoea, epistaxis, haemoptysis, palpitations, chest pain and chronic cough. Examination revealed central cyanosis, digital clubbing, polycythaemia, partial ptosis of right eye, diplopia on right gaze and dilated right pupil. Examination of the chest revealed pectus excavatum but no cardiac murmurs were heard. Investigations revealed a solitary right pulmonary arteriovenous malformation with two feeder vessels which were successfully embolized surgically.
Background - Cardiac mumurs are common in childhood and are often innocent in nature. With careful examination, most innocent murmurs can be reliably diagnosed by a paediatric cardiologist, thus obviating the need for further investigations.
Aim - To look at the prevalence of cardiac murmurs amongst standard one schoolchildren in an urban setting, and calculate the sensitivity, specificity, positive and negative predictive values of clinical diagnosis in differentiating innocent from pathological murmurs.
Methods - One thousand three hundred and fourteen students from 7 primary schools in the district of Gombak were examined during a routine school health examination. Those who were found to have murmurs were referred for echocardiography. A diagnosis was made at the time of clinical examination and following echocardiography. Children with median sternotomy, lateral or posterior thoracotomy scars or those with previously diagnosed cardiac lesions were excludedfrom the study.
Results - Thirty six children were referred for echocardiography out of which 2 were confirmed to have underlying cardiac disease on echocardiography. The prevalence of previously undiagnosed cardiac mumurs in this study was 3%. The sensitivity of clinical examination in diagnosing pathological murmurs was 100% while the specificity was 75%. Positive predictive value was 25% and negative predictive value was 100%. Forty three percent of the students who underwent echocardiography were found to have trivial pulmonary regurgitatibn on Doppler echocardiography.
Conclusion - The prevalence of previously undiagnosed cardiac murmurs is low in this study. This may be due to the fact that they are detected and treated at an earlier age. There is need to conduct a similar study in a rural setting to compare the results.
An 11-year-old intact male Shih Tzu dog was referred to the University Veterinary Hospital (UVH) with history of coughing and laboured breathing. Auscultation revealed that the dog had a left systolic heart murmur grade V/VI at the base of the heart. Radiography showed findings of cardiomegaly and pulmonary oedema. Echocardiography findings revealed that dog has a myxomatous mitral valve disease. The mitral valve was severely thickened and prolapsed into the left atrium. Congestive heart failure (CHF) was treated with an angiotensin converting enzyme (ACE) inhibitor and diuretic. An anti-mucolytic agent was prescribed as a symptomatic treatmentfor the coughing that could be due to mild bronchitis. Dog did not response well with treatment as the frequency of cough was not reduced and the duration was longer each time. Pimobendan was then added on to the initial treatment and there was a tremendous improvement seen from the patient after that. Episodes of productive cough were noticed greatly reduced and dog was much more active at home post two weeks of ACE inhibitor, diuretic and dual-acting inodilator. We successfully maintained the dog with minimal coughing episodes. However, the prognosis is moderate to poor in this case due to possibilities of refraction towards medications.