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[PMID]: 29263486
[Au] Autor:Yuan Y; Shen M; Gao XG
[Ad] Address:Department of Neurology, Peking University People's Hospital, Beijing 100044, China.
[Ti] Title:[Presented with subarachnoid hemorrhage and then blood culture negative infective endocarditis: a case report and literature review].
[So] Source:Beijing Da Xue Xue Bao Yi Xue Ban;49(6):1081-1086, 2017 Dec 18.
[Is] ISSN:1671-167X
[Cp] Country of publication:China
[La] Language:chi
[Ab] Abstract:The patient, a 43-year-old man, had paroxysmal headache three months ago, and he had complained the left occipital sharp pain, which could be alleviated by itself, with alalia and the right side of the upper limb numbness. Head computed tomography (CT) revealed a left temporal lobe intraparenchymal hemorrhage with the left side of the subarachnoid hemorrhage in small quantities. Digital subtraction angiography (DSA) revealed a suspicious aneurysm on the left internal carotid artery siphon. He had intermittent fever 1 month ago, with maximum body temperature 39 °C. He suffered headache again 20 days ago, with pain nature, duration and the way of easing up similar to the earlier onset. General examination demonstrated 2/6 grade blowing systolic murmurs at apex area. Neurological examination revealed that Babinski's sign was positive on the right side. Echocardiographic found an anterior mitral valve ve-getation on the 4th day in hospital. So his clinical diagnosis was infective endocarditis with cerebral embolism. He received vancomycin treatment immediately. His three blood cultures remained negative in hospital. His blood specimens were sent to Chinese Center for Disease Control and Prevention, indirect immunofluorescence method (IFA) IgG antibody detection revealed that the Bartonella henselae IgG antibody was positive. Therefore the clinical diagnosis was Bartonella endocarditis complicated with subarachnoid hemorrhage and cerebral embolism. Bartonella, an intracellular fastidious, gram-negative bacilli, was first documented as a cause of endocarditis in 1993 and since then has been increasingly recognized as an important etiology of infective culture-negative endocarditis. In cases of documented Bartonella endocarditis, the Infectious Diseases Society of America (IDSA) guidelines recommended 2 weeks of gentamicin plus 6 weeks of doxycycline treatment, to achieve a higher cure rate.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171221
[Lr] Last revision date:171221
[St] Status:In-Process

  2 / 1089 MEDLINE  
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[PMID]: 29038418
[Au] Autor:Satti Z; Ibrahim A; Kelly P
[Ad] Address:Department of Cardiology, Cork University Hospital, Cork, Ireland.
[Ti] Title:Two Reports of Quadricuspid Aortic Valve With Aortic Insufficiency.
[So] Source:Rev Cardiovasc Med;18(2):88-91, 2017.
[Is] ISSN:1530-6550
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:We report two cases of a quadricuspid aortic valve with severe aortic incompetence. Both patients presented with dyspnea on exertion. Their physical examinations demonstrated wide pulse pressures with diastolic murmurs. Bedside transthoracic Doppler echocardiography revealed preserved left ventricular systolic function and possible quadricuspid aortic valve with severe aortic incompetence in both patients. We proceeded with transesophageal echocardiography that confirmed a quadricuspid aortic valve with severe aortic incompetence in both patients. Left ventricular systolic function was preserved in both cases. Both patients had a preoperative cardiac catheterization, which showed normal coronary arteries. They were referred to cardiothoracic surgery and underwent successful aortic valve replacement with bioprosthetic valves.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171017
[Lr] Last revision date:171017
[St] Status:In-Data-Review

  3 / 1089 MEDLINE  
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[PMID]: 28985729
[Au] Autor:Garibaldi BT; Niessen T; Gelber AC; Clark B; Lee Y; Madrazo JA; Manesh RS; Apfel A; Lau BD; Liu G; Canzoniero JV; Sperati CJ; Yeh HC; Brotman DJ; Traill TA; Cayea D; Durso SC; Stewart RW; Corretti MC; Kasper EK; Desai SV
[Ad] Address:Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD, 21287, USA. bgariba1@jhmi.edu.
[Ti] Title:A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training.
[So] Source:BMC Med Educ;17(1):182, 2017 Oct 06.
[Is] ISSN:1472-6920
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill. METHODS: One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE). RESULTS: Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE. CONCLUSIONS: A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171007
[Lr] Last revision date:171007
[St] Status:In-Process
[do] DOI:10.1186/s12909-017-1020-2

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[PMID]: 28974851
[Au] Autor:Begic E; Begic Z
[Ad] Address:Faculty of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina.
[Ti] Title:Accidental Heart Murmurs.
[So] Source:Med Arch;71(4):284-287, 2017 Aug.
[Is] ISSN:0350-199X
[Cp] Country of publication:Bosnia and Herzegovina
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Accidental murmurs occur in anatomically and physiologically normal heart. Accidental (innocent) murmurs have their own clearly defined clinical characteristics (asymptomatic, they require minimal follow-up care). AIM: To point out the significance of auscultation of the heart in the differentiation of heart murmurs and show clinical characteristics of accidental heart murmurs. MATERIAL AND METHODS: Article presents review of literature which deals with the issue of accidental heart murmurs in the pediatric cardiology. RESULTS: In the group of accidental murmurs we include classic vibratory parasternal-precordial Stills murmur, pulmonary ejection murmur, the systolic murmur of pulmonary flow in neonates, venous hum, carotid bruit, Potaine murmur, benign cephalic murmur and mammary souffle. CONCLUSION: Accidental heart murmurs are revealed by auscultation in over 50% of children and youth, with a peak occurrence between 3-6 years or 8-12 years of life. Reducing the frequency of murmurs in the later period can be related to poor conduction of the murmur, although the disappearance of murmur in principle is not expected. It is the most common reason of cardiac treatment of the child, and is a common cause of unreasonable concern of parents.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1710
[Cu] Class update date: 171008
[Lr] Last revision date:171008
[St] Status:In-Data-Review
[do] DOI:10.5455/medarh.2017.71.284-287

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[PMID]: 28953006
[Au] Autor:Compostella L; Compostella C; Russo N; Setzu T; Iliceto S; Bellotto F
[Ad] Address:Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy (Drs Compostella, Compostella, Russo, Setzu, and Bellotto); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy (Drs Compostella, Russo, Iliceto, and Bellotto); and Department of Medicine, School of Emergency Medicine, University of Padua, Padova, Italy (Dr Compostella).
[Ti] Title:Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART I: PATIENTS AFTER ACUTE CORONARY SYNDROMES AND HEART FAILURE.
[So] Source:J Cardiopulm Rehabil Prev;, 2017 Aug 04.
[Is] ISSN:1932-751X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170927
[Lr] Last revision date:170927
[St] Status:Publisher
[do] DOI:10.1097/HCR.0000000000000262

  6 / 1089 MEDLINE  
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[PMID]: 28904935
[Au] Autor:Hosseinzadeh J; Maghsoudi Z; Abbasi B; Daneshvar P; Hojjati A; Ghiasvand R
[Ad] Address:Department of Community Nutrition, Food Security Research Center, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
[Ti] Title:Evaluation of Dietary Intakes, Body Composition, and Cardiometabolic Parameters in Adolescent Team Sports Elite Athletes: A Cross-sectional Study.
[So] Source:Adv Biomed Res;6:107, 2017.
[Is] ISSN:2277-9175
[Cp] Country of publication:India
[La] Language:eng
[Ab] Abstract:BACKGROUND: Nutritional intake is an important issue in adolescent athletes. Proper athletes' performance is a multifactorial outcome of good training, body composition, and nutritional status. The aim of the present study was to assess nutritional status, body composition, and cardiometabolic factors in adolescent elite athlete's province of Isfahan, Iran. MATERIALS AND METHODS: In this cross-sectional study, 100 adolescent elite athletes from volleyball, basketball, and soccer teams were selected for the study. Demographic, anthropometric, and cardiometabolic parameters were assessed. Nutritional intakes of participants were recorded using three 24-h recall questioners. RESULTS: Thirty-four female athletes and 66 male athletes participated in this study. Body mass index had not significantly different between the sexes. Energy, protein, carbohydrate, iron, and fat intakes were significantly higher in male athletes ( = 0.02), but calcium and folic acid intakes were not significantly different between the sexes, and Vitamin D intake was significantly higher in females ( = 0.01). Systolic and diastolic blood pressure was significantly higher in males ( = 0.04) and heart rate had not significantly different between the sexes ( = 0.09). Heart murmurs and heart sounds in the majority of participants were normal. CONCLUSION: All the evaluated anthropometric and cardiometabolic parameters were in normal range in the majority of participants. The results showed that dietary intake in these athletes is approximately normal but micronutrients intake status in these athletes needs to be investigated further and longer.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170917
[Lr] Last revision date:170917
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.4103/2277-9175.213667

  7 / 1089 MEDLINE  
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[PMID]: 28787353
[Au] Autor:Compostella L; Compostella C; Russo N; Setzu T; Iliceto S; Bellotto F
[Ad] Address:Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy (Drs Compostella, Compostella, Russo, Setzu, and Bellotto); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy (Drs Compostella, Russo, Iliceto, and Bellotto); and Department of Medicine, School of Emergency Medicine, University of Padua, Padova, Italy (Dr Compostella).
[Ti] Title:Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART I: PATIENTS AFTER ACUTE CORONARY SYNDROMES AND HEART FAILURE.
[So] Source:J Cardiopulm Rehabil Prev;37(5):315-321, 2017 Sep.
[Is] ISSN:1932-751X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1708
[Cu] Class update date: 170831
[Lr] Last revision date:170831
[St] Status:In-Process
[do] DOI:10.1097/HCR.0000000000000262

  8 / 1089 MEDLINE  
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[PMID]: 28787352
[Au] Autor:Compostella L; Russo N; Compostella C; Setzu T; Iliceto S; Bellotto F
[Ad] Address:Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo, Italy (Drs Compostella, Russo, Compostella, Setzu, and Bellotto); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy (Drs Compostella, Russo, Iliceto, and Bellotto); and Department of Medicine, School of Emergency Medicine, University of Padua, Padova, Italy (Dr Compostella).
[Ti] Title:Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART II: ADULT PATIENTS AFTER HEART SURGERY.
[So] Source:J Cardiopulm Rehabil Prev;37(6):397-403, 2017 Nov.
[Is] ISSN:1932-751X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:This clinical skills review describes the most common cardiac auscultatory findings in adults after heart surgery and correlates them with prognostic indicators. It was written for noncardiologist health care providers who work in outpatient cardiac rehabilitation programs.Mechanical prosthetic valves produce typical closing and opening clicks. Listening to their timing and features, as well as to presence and quality of murmurs, contributes to the awareness of potential prosthesis malfunction before other dramatic clinical signs or symptoms become evident. In patients with biological prostheses, murmurs should be carefully evaluated to rule out both valve malfunction and degeneration. Rubs of post-pericardiotomy pericarditis should prompt further investigation for early signs of cardiac tamponade. Third and fourth heart sounds and systolic murmurs in anemic patients should be differentiated from pathological conditions. Relatively new groups of heart surgery patients are those with chronic heart failure treated with continuous-flow left ventricle assist devices. These devices produce characteristic continuous noise that may suddenly disappear or vary in quality and intensity with device malfunction. After heart transplantation, a carefully performed and regularly repeated cardiac auscultation may contribute to suspicion of impending acute rejection. During cardiac rehabilitation, periodic cardiac auscultation may provide useful information regarding clinical-hemodynamic status and allow detection of heralding signs of possible complications in an efficient and low-cost manner.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1708
[Cu] Class update date: 171027
[Lr] Last revision date:171027
[St] Status:In-Process
[do] DOI:10.1097/HCR.0000000000000272

  9 / 1089 MEDLINE  
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[PMID]: 28725332
[Au] Autor:Pierre K; Gadde S; Omar B; Awan GM; Malozzi C
[Ad] Address:Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA.
[Ti] Title:Thyrotoxic Valvulopathy: Case Report and Review of the Literature.
[So] Source:Cardiol Res;8(3):134-138, 2017 Jun.
[Is] ISSN:1923-2829
[Cp] Country of publication:Canada
[La] Language:eng
[Ab] Abstract:We report a 42-year-old female who was admitted for abdominal pain, and also endorsed dyspnea, fatigue and chronic palpitations. Past medical history included asthma, patent ductus arteriosus repaired in childhood and ill-defined thyroid disease. Physical examination revealed blood pressure of 136/88 mm Hg and heart rate of 149 beats per minute. Cardiovascular exam revealed an irregularly irregular rhythm, and pulmonary exam revealed mild expiratory wheezing. Abdomen was tender. Electrocardiogram revealed atrial fibrillation with rapid ventricular response which responded to intravenous diltiazem. Labs revealed TSH of < 0.1 mU/L and free T4 of 2.82 ng/dL, a positive TSH-receptor and thyroid peroxidase antibodies suggesting Grave's thyrotoxicosis. A transthoracic echocardiogram reported an ejection fraction of 55-60%, with mild to moderate mitral regurgitation (MR) and moderate to severe tricuspid regurgitation (TR) and dilated right heart chambers. Pulmonary artery systolic pressure was 52 mm Hg. Transesophageal echocardiogram revealed a myxomatous tricuspid valve with thickening and malcoaptation of the leaflets and moderate to severe TR, mild to moderate MR with mild thickening of the mitral valve leaflets. Abdominal ultrasound revealed wall thickening of the gall bladder concerning for acute cholecystitis. She underwent laparoscopic cholecystectomy and was discharged in stable condition on methimazole for her thyroid disease, and on oral diltiazem for rate control and anticoagulation for atrial fibrillation. Follow-up visit with her cardiologist few months later documented absence of cardiac symptoms, and no murmurs were reported on physical examination. This case underscores the importance of maintaining a high index of suspicion for hyperthyroidism when faced with significant newly diagnosed pulmonary hypertension and TR, as treatment of the thyroid abnormalities can reverse these cardiac findings.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1707
[Cu] Class update date: 170723
[Lr] Last revision date:170723
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.14740/cr564w

  10 / 1089 MEDLINE  
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[PMID]: 28666945
[Au] Autor:Stepien RL; Kellihan HB; Luis Fuentes V
[Ad] Address:Department of Medical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, USA. Electronic address: rebecca.stepien@wisc.edu.
[Ti] Title:Prevalence and diagnostic characteristics of non-clinical mitral regurgitation murmurs in North American Whippets.
[So] Source:J Vet Cardiol;19(4):317-324, 2017 Aug.
[Is] ISSN:1875-0834
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:OBJECTIVES: To assess the prevalence of functional ejection murmurs and murmurs of mitral regurgitation (MR) due to myxomatous mitral valve disease in healthy whippets; to assess the diagnostic value of auscultation to detect MR; and investigate the relationship between age and presence of echocardiographically documented MR (MR ). ANIMALS: A total of 200 healthy client-owned Whippets, recruited at national shows between 2005 and 2009 were involved in this study. METHODS: Cross-sectional study. Dogs were examined by auscultation by one examiner and Doppler echocardiography by another, and results were compared. Prevalence of types of murmurs and MR were calculated and correlated to age. Accuracy of auscultation to predict MR was calculated. RESULTS: Left-sided systolic heart murmurs were detected in 185/200 (93%) of dogs. Left apical systolic murmurs (L ) were detected in 57/200 (29%) and left basilar systolic murmurs (L ) in 128/200 of the dogs (64%). MR was present in 76/200 (38%) dogs. Prevalence MR was correlated with age (r = 0.96, p=0.0028). Mitral regurgitation detected by echocardiography was present in 12/78 (15%) of the dogs ≤ 2 years of age and in 59% of the dogs at 7-8 years old. Detection of L predicted MR with sensitivity 65%, specificity 94%, positive predictive value 86%, and negative predictive value 81%; and accuracy improved when only dogs with more intense L (grade ≥ 3/6) were considered. CONCLUSIONS: Systolic murmurs are common in North American Whippets and this breed exhibits a high prevalence of MR , which may be documented at a relatively early age. Whippets with non-clinical MR may not be identifiable by auscultation alone; echocardiographic examination may be required to exclude a diagnosis of MR. Louder heart murmurs allow more accurate localization in this population.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1707
[Cu] Class update date: 170815
[Lr] Last revision date:170815
[St] Status:In-Process


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