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Cococcetta C, Coutant T, Bagur S, Wernick MB, Huynh M. Use of Digital Stethoscope to Measure Heart Rate in Birds: Comparison of Different Counting Methods Using Phonocardiograms. J Avian Med Surg 2023; 37:108-117. [PMID: 37733450 DOI: 10.1647/22-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The high cardiac contractility of birds poses a challenge to traditional cardiac auscultation, particularly for the accurate determination of heart rate (HR). The objectives of this study were to 1) evaluate the feasibility of using phonocardiograms of adequate length and quality to assess HR in different avian species with a commercially available digital stethoscope, 2) compare 5 counting methods, including 2 direct reading methods (manual counting and using a semiautomatic computerized algorithm as a reference method) and 3 listening methods (progressive mental counting, counting by 10s, and counting with a smartphone application tap counter), and 3) obtain the HR in selected birds and identify a correlation between body weight and HR in different avian species. An inverse correlation on a logarithmic scale was identified between the mean body weight and HR in 60 different bird species (n = 211; R = -0.72, P < 0.0001). Manual reading of phonocardiograms was the most reliable method and had the highest agreement with the reference method; this was followed by the counting by 10s method, the tapping method, and the progressive mental counting method, which was the least reliable. The agreement levels for the different methods were comparable for HRs <200 beats per minute (bpm) in birds weighing >1 kg. For HRs >500 bpm in birds weighing <150 g, only the reading method maintained a good agreement level. A digital stethoscope can be a useful tool for accurately determining the HR in birds, including very small species with high HRs.
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Affiliation(s)
- Ciro Cococcetta
- Service des Nouveaux Animaux de Compagnie Centre Hospitalier Vétérinaire Frégis, 94250 Gentilly, France, cirocococ@ gmail.com
| | - Thomas Coutant
- Service des Nouveaux Animaux de Compagnie Centre Hospitalier Vétérinaire Frégis, 94250 Gentilly, France
| | - Sophie Bagur
- Institut de l'Audition, Institut Pasteur, 75012 Paris, France
| | | | - Minh Huynh
- Service des Nouveaux Animaux de Compagnie Centre Hospitalier Vétérinaire Frégis, 94250 Gentilly, France
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Saponaro V, Mey C, Vonfeld I, Chamagne A, Alvarado M, Cadoré J, Chetboul V, Desquilbet L. Systolic third sound associated with systolic anterior motion of the mitral valve in cats with obstructive hypertrophic cardiomyopathy. J Vet Intern Med 2023; 37:1679-1684. [PMID: 37448142 PMCID: PMC10472982 DOI: 10.1111/jvim.16806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Third heart sounds in cats frequently are associated with hypertrophic cardiomyopathy (HCM) but their exact characterization and timing within the cardiac cycle remains unknown. OBJECTIVES Characterize third heart sounds in cats by phonocardiography and test the ability of 3 observers with different levels of experience and training to recognize third systolic heart sounds in cats. ANIMALS Fifty client-owned cats of different breeds presented for heart screening. METHODS Cats were prospectively assessed using an electronic stethoscope (with digital recording) and then underwent full conventional echocardiographic examination. Audio recordings were blindly assessed in a random order by 3 observers: the cardiologist who collected clinical data, as well as a trained and an untrained junior veterinarian. Cohen's kappa coefficients were calculated to quantify agreement between the opinion of each observer and the echocardiography results (considered the gold standard). RESULTS Twenty cats had a third systolic sound on phonocardiography and an obstructive HCM phenotype with systolic anterior motion of the mitral valve (SAM) on echocardiography. Agreement with echocardiography was very good for the experienced cardiologist, substantial for the trained junior veterinarian, and poor for the untrained junior veterinarian (kappa of 0.92, 0,64, and 0.08, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE We describe here a new auscultatory abnormality in cats with obstructive HCM. It could help a trained non-cardiologist veterinarian in suspecting obstructive HCM in cats based on auscultation only.
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Affiliation(s)
| | - Clémence Mey
- École Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
| | - Irène Vonfeld
- École Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
| | | | | | | | - Valérie Chetboul
- École Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
- Université Paris Est Créteil, INSERM, IMRBCréteilFrance
| | - Loïc Desquilbet
- École Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
- Université Paris Est Créteil, INSERM, IMRBCréteilFrance
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Chetboul V, Bernard P, Passavin P, Tissier R. Congenital ventricular outflow tract obstructions in Boxer dogs: Results of a 17-year cardiovascular breed screening program in France (3126 dogs). PLoS One 2023; 18:e0285458. [PMID: 37167326 PMCID: PMC10174479 DOI: 10.1371/journal.pone.0285458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Ventricular outflow tract obstructions including aortic (AS) and pulmonic stenosis (PS) are the most common canine congenital heart diseases, with Boxer dogs being predominantly affected. This has led to the French Boxer club adopting a mandatory national control program against AS and PS. The objective of this retrospective study was to analyze the results of 17 years of this cardiovascular breed screening program (2005-2021). MATERIALS AND METHODS The records of untreated and non-anesthetized adult Boxer dogs screened between 2005 and 2021 were retrospectively reviewed. All dogs underwent physical examination and standard transthoracic echocardiography with concomitant ECG tracing. All examinations were reviewed by one single board-certified specialist in cardiology. RESULTS Out of the 3126 dogs screened during the study period, 3001 dogs (female:male sex ratio = 2.2, median age [IQR] = 1.6 years [1.2-2.1]) were recruited for data analysis. A total of 218 operators were involved in the screening program. For most Boxer dogs (i.e., 93.8% for AS and 94.5% for PS), a single examination was required to obtain a definitive cardiac status, although most operators were non-specialist general practitioners. A left basilar systolic heart murmur was detected in all dogs with AS and PS, but also in 7.4% dogs free of heart diseases. A significantly higher proportion of the latter was detected when operators were board-certified specialists (P<0.001). Lastly, when comparing the start and the end of the breeding program, among dogs diagnosed with AS and PS (n = 364) in a French referral cardiology center, Boxer went from the 1st affected breed by AS to the 3rd, and from the 3rd affected breed by PS to the 6th. CONCLUSION This 17-year screening program has experienced a strong involvement of veterinarians, breeders, and owners throughout France. This may have contributed to reduce AS and PS prevalence in Boxer dogs at the studied referral cardiology center.
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Affiliation(s)
- Valérie Chetboul
- Unité de Cardiologie d'Alfort, CHUV-Ac, École nationale vétérinaire d'Alfort, Maisons-Alfort, France
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Pauline Bernard
- Unité de Médecine Interne, CHUV-Ac, École nationale vétérinaire d'Alfort, Maisons-Alfort, France
| | - Peggy Passavin
- Unité de Cardiologie d'Alfort, CHUV-Ac, École nationale vétérinaire d'Alfort, Maisons-Alfort, France
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Rigterink D, L'Herminez MA, Szatmári V. Temporal changes in the presence and intensity of innocent cardiac murmurs in clinically healthy Cairn terrier and Dachshund puppies between 4 and 8 weeks of age. Vet Rec 2021; 190:e1173. [PMID: 34807995 DOI: 10.1002/vetr.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Spontaneous week-to-week variation in the presence and intensity of innocent cardiac murmurs in individual puppies is unknown. METHODS Sixty privately owned, clinically healthy Cairn terrier and Dachshund puppies between 4 and 8 weeks of age were included. All dogs underwent weekly cardiac auscultation at the breeders' home by a veterinary cardiology specialist using an acoustic stethoscope. On each occasion, a phonocardiogram was recorded with an electronic stethoscope. Furthermore, all dogs were auscultated once at a first opinion veterinary practise and once at the authors' institution, where they also underwent an echocardiographic examination. RESULTS Two-hundred and eighty-one auscultations were conducted on 32 Cairn terriers and 28 Dachshunds, at the breeders' homes. Innocent murmurs were detected in 19 puppies. Two of these puppies had a detectable murmur on each auscultation. In five of the puppies, the murmur became undetectable during the observation period and in 12 puppies the murmur was intermittently audible. Auscultation at the authors' institution had an unpredictable effect on murmur presence and intensity. Phonocardiography revealed murmurs in 42 puppies. Interpretation of phonocardiograms by two independent observers showed nearly perfect agreement (κ = 0.859). CONCLUSIONS Remarkable and unpredictable spontaneous week-to-week variation was documented in the presence and intensity of innocent murmurs.
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Affiliation(s)
- Donny Rigterink
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Mariska A L'Herminez
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Viktor Szatmári
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Wilshaw J, Rosenthal SL, Wess G, Dickson D, Bevilacqua L, Dutton E, Deinert M, Abrantes R, Schneider I, Oyama MA, Gordon SG, Elliott J, Xia D, Boswood A. Accuracy of history, physical examination, cardiac biomarkers, and biochemical variables in identifying dogs with stage B2 degenerative mitral valve disease. J Vet Intern Med 2021; 35:755-770. [PMID: 33645846 PMCID: PMC7995403 DOI: 10.1111/jvim.16083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/26/2021] [Accepted: 02/11/2021] [Indexed: 01/26/2023] Open
Abstract
Background Treatment is indicated in dogs with preclinical degenerative mitral valve disease (DMVD) and cardiomegaly (stage B2). This is best diagnosed using echocardiography; however, relying upon this limits access to accurate diagnosis. Objectives To evaluate whether cardiac biomarker concentrations can be used alongside other clinical data to identify stage B2 dogs. Animals Client‐owned dogs (n = 1887) with preclinical DMVD prospectively sampled in Germany, the United Kingdom, and the United States. Methods Dogs that met inclusion criteria and were not receiving pimobendan (n = 1245) were used for model development. Explanatory (multivariable logistic regression) and predictive models were developed using clinical observations, biochemistry, and cardiac biomarker concentrations, with echocardiographically confirmed stage B2 disease as the outcome. Receiver operating characteristic curves assessed the ability to identify stage B2 dogs. Results Age, appetite, serum alanine aminotransferase activity, body condition, serum creatinine concentration, murmur intensity, and plasma N‐terminal propeptide of B‐type natriuretic peptide (NT‐proBNP) concentration were independently associated with the likelihood of being stage B2. The discriminatory ability of this explanatory model (area under curve [AUC], 0.84; 95% confidence interval [CI], 0.82‐0.87) was superior to NT‐proBNP (AUC, 0.77; 95% CI, 0.74‐0.80) or the vertebral heart score alone (AUC, 0.76; 95% CI, 0.69‐0.83). A predictive logistic regression model could identify the probability of being stage B2 (AUC test set, 0.86; 95% CI, 0.81‐0.91). Conclusion and Clinical Importance Our findings indicate accessible measurements could be used to screen dogs with preclinical DMVD. Encouraging at‐risk dogs to seek further evaluation could result in a greater proportion of cases being appropriately managed.
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Affiliation(s)
- Jenny Wilshaw
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
| | | | - Gerhard Wess
- Clinic of Small Animal Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | | | | | | | | | | | - Mark A Oyama
- Department of Veterinary Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sonya G Gordon
- College of Veterinary Medicine, Texas A&M University, College Station, Texas, USA
| | - Jonathan Elliott
- Department of Comparative Biomedical Science, Royal Veterinary College, University of London, London, UK
| | - Dong Xia
- Research Support Office, Royal Veterinary College, University of London, London, UK
| | - Adrian Boswood
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
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van Staveren MDB, Szatmári V. Detecting and recording cardiac murmurs in clinically healthy puppies in first opinion veterinary practice at the first health check. Acta Vet Scand 2020; 62:37. [PMID: 32586343 PMCID: PMC7315505 DOI: 10.1186/s13028-020-00535-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background The frequency that cardiac murmurs are identified and recorded in first opinion veterinary practices at the first health check in puppies is unknown. The aims of the study were to assess the agreement between first opinion veterinary practitioners, a veterinary student and a veterinary cardiology specialist on detecting murmurs, and to establish whether abnormal auscultation findings had been recorded in the health certificates of clinically healthy puppies. The study included prospective and retrospective investigations, where the prospectively collected auscultation findings from a veterinary cardiology specialist and a trained veterinary student were compared to auscultation findings recorded by first opinion veterinary practitioners. Results Cardiac auscultation was performed on 331 client-owned, clinically healthy dogs at two time points: at age 34–69 days by a first opinion veterinary practitioner and at age 45–76 days, on average 9 days later, by a veterinary cardiology specialist and a trained veterinary student. Agreement among the three was compared for the presence of a murmur. The degree of inter-observer agreement was evaluated using Cohen’s kappa. Auscultation findings, as noted in the pets’ passports, from 331 puppies and 43 different first opinion veterinary practices, were retrospectively reviewed and prospectively compared with auscultation findings from a veterinary cardiology specialist. Agreement between the veterinary cardiology specialist and the first opinion veterinary practitioners was poor (ϰ = 0.01) and significantly different (P < 0.001). First opinion veterinary practitioners had recorded a cardiac murmur in only 1 of the 97 puppies in which the veterinary cardiology specialist detected a murmur. Two-hundred-and-fifty-two puppies were auscultated by both the veterinary cardiology specialist and the student. Their agreement was fair (ϰ = 0.40) and significantly different (P = 0.024). The agreement between the student and a first opinion veterinary practitioner on these 252 puppies was poor (ϰ = 0.03) and significantly different (P < 0.001). Conclusions This study shows that soft cardiac murmurs are rarely documented during the first veterinary health check in puppies by first opinion veterinary practitioners. Although soft murmurs may not be clinically relevant, finding and recording them is evidence of a carefully performed auscultation. Missing a non-pathological murmur is not of clinical importance; however, missing a pathological murmur could prove detrimental for the individual puppy.
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Rishniw M, Caivano D, Dickson D, Swift S, Rouben C, Dennis S, Sammarco C, Lustgarten J, Ljungvall I. Breed does not affect the association between murmur intensity and disease severity in dogs with pulmonic or subaortic stenosis. J Small Anim Pract 2019; 60:493-498. [PMID: 31032935 DOI: 10.1111/jsap.13015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 03/01/2019] [Accepted: 03/28/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether breed affects the ability of murmur intensity to predict the severity of stenosis in dogs with pulmonic stenosis or subaortic stenosis. MATERIALS AND METHODS Retrospective multi-investigator study of dogs with pulmonic stenosis or subaortic stenosis. Murmur intensity, assessed by a four-level classification scheme, was compared with echocardiographically-determined pressure gradient across the affected valve. Breeds represented by at least 10 dogs at any murmur intensity were compared to determine the effect, if any, of breed. RESULTS A total of 1088 dogs (520 with pulmonic stenosis and 568 with subaortic stenosis, representing 106 breeds and the mixed breed group) were included; 208 dogs had soft, 210 had moderate, 283 had loud and 387 had palpable murmurs. Fifteen breeds were represented by at least 10 dogs: five breeds with at least 10 dogs had soft murmurs (132 dogs), nine breeds had moderate murmurs (149 dogs), 10 breeds had loud murmurs (188 dogs), and 11 breeds had palpable murmurs (286 dogs). No breeds differed in stenosis severity from any other breeds within any murmur grade. Post hoc power calculations suggested that we would have been able to detect at least a moderate or large effect size, had one existed. Several dogs with soft murmurs had more-than-mild disease severity. CLINICAL SIGNIFICANCE Despite anecdotally perceived differences in the detection of heart murmurs between breeds, which have been proposed to potentially affect the interpretation of stenosis severity, we found no obvious breed effect in the ability to predict severity of stenosis.
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Affiliation(s)
- M Rishniw
- Veterinary Information Network, Davis, California, 95616, USA
| | - D Caivano
- Department of Veterinary Medicine, University of Perugia, Perugia, 06126, Italy
| | - D Dickson
- HeartVets, Porthcawl, Wales, CF36 5LD, UK
| | - S Swift
- Department of Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, 32610, USA
| | - C Rouben
- Department of Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, 32610, USA
| | - S Dennis
- Hope Veterinary Specialists, Malvern, Pennsylvania, 19355, USA
| | - C Sammarco
- Red Bank Veterinary Hospital, Tinton Falls, New Jersey, 07724, USA
| | - J Lustgarten
- Red Bank Veterinary Hospital, Tinton Falls, New Jersey, 07724, USA
| | - I Ljungvall
- Department of Clinical Sciences, University Animal Hospital, Swedish University of Agricultural Science, Uppsala, SE-750 07, Sweden
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Stepien RL, Kellihan HB, Luis Fuentes V. Prevalence and diagnostic characteristics of non-clinical mitral regurgitation murmurs in North American Whippets. J Vet Cardiol 2017; 19:317-324. [PMID: 28666945 DOI: 10.1016/j.jvc.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/15/2017] [Accepted: 04/10/2017] [Indexed: 11/13/2022]
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 (MRecho). 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 MRecho were calculated and correlated to age. Accuracy of auscultation to predict MRecho was calculated. RESULTS Left-sided systolic heart murmurs were detected in 185/200 (93%) of dogs. Left apical systolic murmurs (Lapex) were detected in 57/200 (29%) and left basilar systolic murmurs (Lbase) in 128/200 of the dogs (64%). MRecho was present in 76/200 (38%) dogs. Prevalence MRecho 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 Lapex predicted MRecho with sensitivity 65%, specificity 94%, positive predictive value 86%, and negative predictive value 81%; and accuracy improved when only dogs with more intense Lapex (grade ≥ 3/6) were considered. CONCLUSIONS Systolic murmurs are common in North American Whippets and this breed exhibits a high prevalence of MRecho, which may be documented at a relatively early age. Whippets with non-clinical MRecho 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.
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Affiliation(s)
- R L Stepien
- Department of Medical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, USA.
| | - H B Kellihan
- Department of Medical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, USA
| | - V Luis Fuentes
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
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Affiliation(s)
- Sonja Fonfara
- Small Animal Cardiorespiratory Medicine, School of Veterinary Sciences; University of Bristol
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Drut A, Ribas T, Floch F, Franchequin S, Freyburger L, Rannou B, Cadoré JL, Bublot I. Prevalence of physiological heart murmurs in a population of 95 healthy young adult dogs. J Small Anim Pract 2014; 56:112-8. [PMID: 25440774 DOI: 10.1111/jsap.12300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/01/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence of physiological heart murmurs in healthy young adult dogs. MATERIALS AND METHODS Healthy dogs aged between 1 and 5 years were enrolled prospectively. All participating dogs underwent physical examination, urinalysis, blood testing and blood pressure measurement. Cardiac auscultations were performed by three independent examiners. Dogs with heart murmurs underwent echocardiography, to exclude cardiovascular abnormalities. RESULTS Of 109 dogs evaluated, 95 completed the study. Heart murmurs were detected in 22 dogs. Interobserver agreement for murmur detection was moderate to fair (weighted kappa 0 · 29-0 · 56). On the basis of two different sets of echocardiographic criteria, physiological heart murmurs were diagnosed in 6 and 11 dogs, respectively, giving a prevalence of 6-12%. All physiological heart murmurs were systolic and low-grade (I-III/VI). Most were louder towards the left heart base and some radiated up to the thoracic inlet. The epidemiological features of dogs with physiological heart murmurs did not differ significantly from those of dogs without murmurs (P > 0 · 10). CLINICAL SIGNIFICANCE This study shows that physiological heart murmurs may not be limited to growing dogs or specific breeds, as they were commonly encountered in this population of healthy young adult dogs.
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Affiliation(s)
- A Drut
- Service de Médecine Interne, VetAgro Sup Lyon Campus Vétérinaire, Université de Lyon, 69280, Marcy l'Etoile, Lyon, France
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Pradelli D, Quintavalla C, Crosta MC, Mazzoni L, Oliveira P, Scotti L, Brambilla P, Bussadori C. The influence of emotional stress on Doppler-derived aortic peak velocity in boxer dogs. J Vet Intern Med 2014; 28:1724-30. [PMID: 25312007 PMCID: PMC4895642 DOI: 10.1111/jvim.12434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/23/2014] [Accepted: 07/14/2014] [Indexed: 11/29/2022] Open
Abstract
Background Subaortic stenosis (SAS) is a common congenital heart disease in Boxers. Doppler‐derived aortic peak velocity (AoPV) is a diagnostic criterion for the disease. Objectives To investigate the influence of emotional stress during echocardiographic examination on AoPV in normal and SAS‐affected Boxers. To evaluate the effects of aortic root diameters on AoPV in normal Boxers. Dogs Two hundred and fifteen normal and 19 SAS‐affected Boxers. Methods The AoPV was recorded at the beginning of echocardiographic examination (T0), and when the emotional stress of the dog was assumed to decrease based on behavioral parameters and heart rate (T1). AoPV0–AoPV1 was calculated. In normal dogs, stroke volume index was calculated at T0 and T1. Aortic root diameters were measured and their relationship with AoPV and AoPV0–AoPV1 was evaluated. Results In normal dogs, AoPV was higher at T0 (median, 1.95 m/s; range, 1.60–2.50 m/s) than at T1 (median, 1.76 m/s; range, 1.40–2.20 m/s; P < .0001; reduction 9.2%). The stroke volume index at T0 also was greater than at T1 (P < .0001). Weak negative correlations were detected between aortic root size and aortic velocities. In SAS‐affected dogs, AoPV0 was higher than AoPV1 (P < .0001; reduction 7.3%). Conclusion and Clinical Importance Aortic peak velocity was affected by emotional stress during echocardiographic examination both in SAS‐affected and normal Boxers. In normal Boxers, aortic root size weakly affected AoPVs, but did not affect AoPV0–AoPV1. Stroke volume seems to play a major role in stress‐related AoPV increases in normal Boxers. Emotional stress should be taken into account when screening for SAS in the Boxer breed.
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Affiliation(s)
- D Pradelli
- Clinica Veterinaria "Gran Sasso", Milan, Italy
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Blass KA, Schober KE, Bonagura JD, Scansen BA, Visser LC, Lu J, Smith DN, Ward JL. Clinical evaluation of the 3M Littmann Electronic Stethoscope Model 3200 in 150 cats. J Feline Med Surg 2013; 15:893-900. [PMID: 23599254 DOI: 10.1177/1098612x13485480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Detection of murmurs and gallops may help to identify cats with heart disease. However, auscultatory findings may be subject to clinically relevant observer variation. The objective of this study was to evaluate an electronic stethoscope (ES) in cats. We hypothesized that the ES would perform at least as well as a conventional stethoscope (CS) in the detection of abnormal heart sounds. One hundred and fifty consecutive cats undergoing echocardiography were enrolled prospectively. Cats were ausculted with a CS (WA Tycos Harvey Elite) by two observers, and heart sounds were recorded digitally using an ES (3M Littmann Stethoscope Model 3200) for off-line analysis. Echocardiography was used as the clinical standard method for validation of auscultatory findings. Additionally, digital recordings (DRs) were assessed by eight independent observers with various levels of expertise, and compared using interclass correlation and Cohen's weighted kappa analyses. Using the CS, a heart murmur (n = 88 cats) or gallop sound (n = 17) was identified in 105 cats, whereas 45 cats lacked abnormal heart sounds. There was good total agreement (83-90%) between the two observers using the CS. In contrast, there was only moderate agreement (P <0.001) between results from the CS and the DRs for murmurs, and poor agreement for gallops. The CS was more sensitive compared with the DRs with regard to murmurs and gallops. Agreement among the eight observers was good-to-excellent for murmur detection (81%). In conclusion, DRs made with the ES are less sensitive but comparably specific to a CS at detecting abnormal heart sounds in cats.
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Affiliation(s)
- Keith A Blass
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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Bavegems VC, Duchateau L, Polis IE, Van Ham LM, De Rick AF, Sys SU. Detection of innocent systolic murmurs by auscultation and their relation to hematologic and echocardiographic findings in clinically normal Whippets. J Am Vet Med Assoc 2011; 238:468-71. [PMID: 21320016 DOI: 10.2460/javma.238.4.468] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine murmur prevalence by auscultation of 105 apparently healthy Whippets without signs of cardiac disease, to determine the origin of these murmurs, and to evaluate the influence of sex, type of pedigree (ie, bred for showing or racing), and training on these murmurs. DESIGN Cross-sectional study. ANIMALS 105 client-owned Whippets. PROCEDURES All dogs were auscultated by the first author and underwent a complete physical and cardiological examination, together with a hematologic assessment. Several RBC variables and echocardiographic variables were compared between dogs with or without a murmur at the level of the aortic valve. RESULTS 44 of 105 (41.9%) dogs had no murmur. A soft systolic murmur was present with point of maximal intensity at the level of the aortic valve in 50 (47.6%) dogs, at the level of the pulmonic valve in 8 (7.6%) dogs, and at the level of the mitral valve in 3 (2.9%) dogs. No significant differences were found in heart rate, rhythm, murmur presence, point of maximal intensity, and murmur grade between males and females, between dogs with race- and show-type pedigrees, or between dogs in training and not in training. Dogs with a murmur at the level of the aortic valve had a significantly higher aortic and pulmonic blood flow velocity and cardiac output, compared with dogs without a murmur. CONCLUSIONS AND CLINICAL RELEVANCE Whippets have a high prevalence of soft systolic murmurs in the absence of any structural abnormalities, which fit the description of innocent murmurs. No influence of sex, pedigree type, or training was found on the occurrence of these murmurs in Whippets.
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Affiliation(s)
- Valérie C Bavegems
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium.
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Vörös K, Nolte I, Hungerbühler S, Reiczigel J, Ehlers J, Tater G, Mischke R, Zimmering T, Schneider M. Sound recording and digital phonocardiography of cardiac murmurs in dogs by using a sensor-based electronic stethoscope. Acta Vet Hung 2011; 59:23-35. [PMID: 21354939 DOI: 10.1556/avet.59.2011.1.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The goals of this study were to present a technique of digitalised sound recordings and phonocardiograms (dPCGs), and to analyse its diagnostic capabilities. Heart sounds of 20 dogs were auscultated in vivo (on-line) and recorded with dPCGs by two authors using a Welch Allyn Meditron Stethoscope System. Sound recordings were auscultated off-line and blindly by four different observers having various auscultatory experiences, then listened to while viewing dPCGs. The results were compared to echocardiographic diagnoses. There was a significant agreement (p < 0.001) between on-line and off-line auscultatory findings regarding the four observers, ranging from 45% to 75% (weighted kappa values: 0.72 to 0.87). The best agreement was achieved by Observer 1 having the highest experience. Significant differences (p < 0.05) were found between Observer 1 and Observer 4 (with the lowest experience) in judging the quality of the murmurs during the off-line and blind auscultation. However, there were only minimal differences (95% to 100% agreements) in dPCG analyses among the four observers regarding intensity and quality of the murmurs while simultaneously listening to and viewing the dPCGs. Significant correlations were found between the traditional '0 to 6 scale' and a new '0 to 3 scale' murmur intensity gradings by all observers (correlation coefficients 0.640 to 0.908; p < 0.01 to p < 0.001). Analysis of dPCGs might be a valuable, additional tool helping with the diagnosis of canine cardiac murmurs, especially for those with less cardiological experience.
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Affiliation(s)
| | - Ingo Nolte
- 1 University of Veterinary Medicine Hanover Small Animal Clinic Bünteweg 9 D-30559 Hanover Germany
| | - Stephan Hungerbühler
- 1 University of Veterinary Medicine Hanover Small Animal Clinic Bünteweg 9 D-30559 Hanover Germany
| | - Jenő Reiczigel
- 3 Szent István University Department of Biomathematics and Informatics, Faculty of Veterinary Science Budapest Hungary
| | - Jan Ehlers
- 2 University of Veterinary Medicine Hanover E-Learning Consultant Bünteweg 9 D-30559 Hanover Germany
| | - Guy Tater
- 1 University of Veterinary Medicine Hanover Small Animal Clinic Bünteweg 9 D-30559 Hanover Germany
| | - Reinhard Mischke
- 1 University of Veterinary Medicine Hanover Small Animal Clinic Bünteweg 9 D-30559 Hanover Germany
| | - Tanja Zimmering
- 1 University of Veterinary Medicine Hanover Small Animal Clinic Bünteweg 9 D-30559 Hanover Germany
| | - Matthias Schneider
- 4 Justus-Liebig University Giessen Small Animal Clinic, Veterinary Faculty Giessen Germany
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Abstract
OBJECTIVES To investigate the prevalence and progression of murmurs and the development of the left ventricular outflow tract (LVOT) and flow velocities in the great arteries in boxer puppies through adolescence until three years of age. METHODS Nineteen boxer puppies with or without a low-intensity murmur, but without evidence of congenital heart disease, were studied prospectively. Examinations were carried out at 7 weeks, 3, 4, 6, 9, 12 and 36 months of age by cardiac auscultation and Doppler echocardiography. RESULTS Presence and intensity of heart murmurs varied in the same dog and between dogs, but flow velocities did not change. Estimated effective orifice diameter (EOD) and indexed EOD was significantly narrower than measured subvalvular and valvular diameters. CLINICAL SIGNIFICANCE The variability in presence and intensity of low-intensity ejection murmurs is high during growth in boxers.
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Affiliation(s)
- K Höglund
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden
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16
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Wagner T, Fuentes VL, Payne JR, McDermott N, Brodbelt D. Comparison of auscultatory and echocardiographic findings in healthy adult cats. J Vet Cardiol 2010; 12:171-82. [PMID: 21075067 DOI: 10.1016/j.jvc.2010.05.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 05/12/2010] [Accepted: 05/25/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This pilot study was performed to investigate murmur prevalence and to explore the association between auscultatory and echocardiographic findings in apparently healthy cats in order to design a larger study. ANIMALS, MATERIALS AND METHODS Adult cats in 4 rehoming centres were screened by auscultation and echocardiography (echo) over 2 periods of 2 weeks each. In the first period, echo was attempted only in cats with murmurs. In the second period, all cats underwent auscultation by 2 observers and echo. LVH was defined in 5 ways: maximal diastolic left ventricular (LV) wall thickness ≥ 6 mm or ≥ 5.5 mm with 2D (LVH(6 2D), LVH(5.5 2D), respectively) or M-Mode echo (LVH(6 MM) or LVH(5.5 MM) respectively), or LV wall thickness ≥ 6 mm (2D) for >50% of a wall segment (LVH(50%)). RESULTS 67/199 (34%) cats had a murmur. Interobserver agreement on murmur presence was moderate (κ 0.47). 61 cats with a murmur and 31 cats without underwent both auscultation and echo. Depending on the criteria, LVH was present in 31 (LVH(6 2D)), 21 (LVH(50%)) and 11 (LVH(6 MM)) scanned cats. 18-62% of cats with murmurs had LVH, depending on the echo criteria used. Agreement was best between observers in identifying LVH using LVH(6 2D) and LVH(50%) (κ = 1.0). CONCLUSIONS Heart murmurs are common in apparently healthy cats. The prevalence of LVH varies depending on the criteria used.
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Ljungvall I, Ahlstrom C, Höglund K, Hult P, Kvart C, Borgarelli M, Ask P, Häggström J. Use of signal analysis of heart sounds and murmurs to assess severity of mitral valve regurgitation attributable to myxomatous mitral valve disease in dogs. Am J Vet Res 2009; 70:604-13. [DOI: 10.2460/ajvr.70.5.604] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Höglund K, Ahlstrom CHG, Häggström J, Ask PNA, Hult PHP, Kvart C. Time-frequency and complexity analyses for differentiation of physiologic murmurs from heart murmurs caused by aortic stenosis in Boxers. Am J Vet Res 2007; 68:962-9. [PMID: 17764410 DOI: 10.2460/ajvr.68.9.962] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate whether time-frequency and complexity analyses of heart murmurs can be used to differentiate physiologic murmurs from murmurs caused by aortic stenosis (AS) in Boxers. ANIMALS 27 Boxers with murmurs. PROCEDURES Dogs were evaluated via auscultation and echocardiography. Analyses of time-frequency properties (TFPs; ie, maximal murmur frequency and duration of murmur frequency > 200 Hz) and correlation dimension (T(2)) of murmurs were performed on phonocardiographic sound data. Time-frequency property and T(2) analyses of low-intensity murmurs in 16 dogs without AS were performed at 7 weeks and 12 months of age. Additionally, TFP and T(2) analyses were performed on data obtained from 11 adult AS-affected dogs with murmurs. RESULTS In dogs with low-intensity murmurs, TFP or T(2) values at 7 weeks and 12 months did not differ significantly. For differentiation of physiologic murmurs from murmurs caused by mild AS, duration of murmur frequency > 200 Hz was useful and the combination assessment of duration of frequency > 200 Hz and T(2) of the murmur had a sensitivity of 94% and a specificity of 82%. Maximal murmur frequency did not differentiate dogs with AS from those without AS. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that assessment of the duration of murmur frequency > 200 Hz can be used to distinguish physiologic heart murmurs from murmurs caused by mild AS in Boxers. Combination of this analysis with T(2) analysis may be a useful complementary method for diagnostic assessment of cardiovascular function in dogs.
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Affiliation(s)
- Katja Höglund
- Department of Anatomy and Physiology, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, 750 07 Uppsala, Sweden
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Höglund K, Bussadori C, Domenech O, Häggström J, Pradelli D, Kvart C. Contrast echocardiography in Boxer dogs with and without aortic stenosis. J Vet Cardiol 2007; 9:15-24. [DOI: 10.1016/j.jvc.2006.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 01/14/2006] [Accepted: 02/18/2006] [Indexed: 11/18/2022]
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Linde A, Koch J. Screening for aortic stenosis in the Boxer: Auscultatory, ECG, blood pressure and Doppler echocardiographic findings. J Vet Cardiol 2006; 8:79-86. [PMID: 19083341 DOI: 10.1016/j.jvc.2006.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Revised: 01/19/2006] [Accepted: 02/27/2006] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study was conducted to estimate the incidence of aortic stenosis (AS) in a group of Boxers evaluated by auscultation, ECG, blood pressure measurement and Doppler-echocardiography. BACKGROUND The Boxer is a breed at significantly increased risk of AS. The prevalence of murmurs and Doppler-echocardiographic findings consistent with AS in this breed is reportedly high. ANIMALS, MATERIALS AND METHODS Eighty-nine Boxers were evaluated by auscultation, and final murmur grade recorded after stress testing. Doppler echocardiography was performed in fifty-five adult Boxers. Electrocardiograms (ECG, n=53), non-invasive blood pressure measurement (n=32), and Holter monitoring (n=24) were performed in selected dogs. Degree of AS was based on the aortic peak flow velocity (Ao PFV). Final Ao PFV was recorded as the highest value obtained after stress testing. AS was defined as an Ao PFV>2m/s on continuous wave Doppler, using the subcostal window. Pressure gradients (Deltap) were calculated using the modified Bernoulli equation (Deltap=4V(2)). Mild AS was defined as Deltap=16-40mmHg, moderate AS Deltap=40-75mmHg, and severe AS Deltap>75mmHg. RESULTS 62% of adult Boxers evaluated by echocardiography had an Ao PFV>2m/s suggestive of AS. Systolic basilar ejection murmurs were diagnosed in 73%. Murmur intensity showed a statistically significant correlation with Ao PFV (p<0.05). ECG abnormalities were only detected in dogs with severe AS. CONCLUSION The study reports on systolic murmurs and Doppler-echocardiographic findings consistent with AS, as well as ECG and blood pressure measurements in a sample of pure-breed Boxers.
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Affiliation(s)
- Annika Linde
- Department of Anatomy and Physiology, Kansas State University, 140 Justin Hall, Manhattan, KS 66506-1407, USA
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Chetboul V, Trollé JM, Nicolle A, Carlos Sampedrano C, Gouni V, Laforge H, Benalloul T, Tissier R, Pouchelon JL. Congenital Heart Diseases in the Boxer Dog: A Retrospective Study of 105 Cases (1998â2005). ACTA ACUST UNITED AC 2006; 53:346-51. [PMID: 16922831 DOI: 10.1111/j.1439-0442.2006.00865.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Subaortic stenosis (SAS) is one of the most common congenital heart diseases (CHD) in dogs with Boxers being predominantly affected. However, the increasing availability of modern diagnostic imaging systems now allows a better assessment of cardiac morphology and function, thereby facilitating early detection of CHD in awake animals. In this context, the case records of Boxer dogs diagnosed with CHD using echocardiography combined with Doppler mode, were retrospectively reviewed (1998-2005). One hundred and five Boxers exhibiting either a single CHD (53/105, 50.5%) or association of several CHD (52/105, 49.5%) were included. The most common CHD was atrial septal defect (ASD) observed in 56.2% of these animals (59/105), followed by mitral dysplasia (58/105, 55.2%), and SAS (49/105, 46.7%). SAS was associated with one or two CHD in 29.5% of cases (31/105). Most of the dogs with a low intensity left heart base systolic murmur had an isolated ASD whereas most of the dogs with a similar but high intensity murmur had SAS, either isolated or associated with a concurrent CHD. The incidence of ASD and mitral dysplasia in Boxer dogs is higher than previously assumed, and ASD is a common cause of left heart base systolic murmur in this breed of dog. This confirms that the detection of such a murmur should not be used as the unique criterion for diagnostic confirmation of SAS.
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Affiliation(s)
- V Chetboul
- Cardiology Unit of Alfort, National Veterinary School of Alfort, 7 avenue du General de Gaulle, 94704 Maisons-Alfort cedex, France.
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