An 11-year-old, castrated male dog presented with a 3-month history of cough and depression. Auscultation revealed systolic murmur and thoracic radiographs showing enlargement of both the atrium and left ventricle. Echocardiography showed thickened mitral valve and moderate-to-severe left atrial enlargement. Additionally, M-mode echocardiography showed symmetric left ventricular wall thickening and systolic anterior motion of the mitral valve, while Doppler imaging revealed high velocity turbulent flow through the left ventricular outflow tract. Based on echocardiography, this case was diagnosed with hypertrophic obstructive cardiomyopathy. After 5 months, the dog was clinically static in radiography and echocardiography.
Animals ; Auscultation ; Cardiomyopathy, Hypertrophic ; Child ; Cough ; Depression ; Dogs ; Echocardiography ; Heart Ventricles ; Humans ; Male ; Mitral Valve ; Radiography ; Systolic Murmurs

A 6-month-old mature intact female Siamese cat presented with exertional dyspnea. Diagnostic studies revealed pleural effusion, grade 4/6 left basal systolic murmur, deep S-wave in electrocardiograph leads I, II, and III, cardiomegaly with pleural effusion on radiography, pulmonic systolic (~5.8 m/sec) and tricuspid (3.6 m/sec) regurgitant jets, atrial septal defect, and a hypoplastic right outflow tract. Based on these results, the case was diagnosed as pulmonic stenosis with atrial septal defect. To the best of our knowledge, this is the first case report describing pulmonic stenosis with atrial septal defect in a cat in Korea.
Animals ; Cardiomegaly ; Cats* ; Dyspnea ; Electrocardiography ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Humans ; Infant ; Korea ; Pleural Effusion ; Pulmonary Valve Stenosis* ; Radiography ; Systolic Murmurs

No abstract available.
Anticoagulants ; Echocardiography, Transesophageal ; Embolism ; Endocarditis ; Endocarditis, Bacterial ; Heart Valve Prosthesis ; Heart Ventricles ; Hemodynamics ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Outpatients ; Pneumonia ; Systolic Murmurs ; Warfarin ; Humans

BACKGROUND: An accessory mitral valve leaflet is a rare congenital anomaly usually associated with left ventricular outflow tract (LVOT) obstruction. Fewer than 100 cases have been reported mostly occurring in children.

CASE: An asymptomatic 43-year-old female who came in for pre employment clearance was noted to have a systolic murmur. Echocardiography revealed an accessory mitral valve tissue attached to the anterior mitral valve leaflet. There was also a significant gradient noted across the LVOT. Patient is presently asymptomatic and she was advised follow up for serial echocardiographic monitoring.

DIAGNOSTICS: Twelve lead electrocardiogram showed normal sinus rhythm with normal axis, poor R wave progression and no chamber enlargement. Chest radiography was normal. 2D Echo revealed an echogenic, parachute-like structure billowing into the LVOT during systole. Interrogation of the said structure using Doppler revealed a significant pressure gradient of 45mmHg along the LVOT.

CONCLUSION: Accessory mitral valve with LVOT obstruction is an unusual finding. Clinical and echocardiographic recognition as well as surveillance is warranted in these patients. This is also important for determination of definitive management.

Human ; Female ; Adult ; Mitral Valve ; Systole ; Systolic Murmurs ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Employment

A 6 year-old, spayed female, Maltese dog was presented with precordial thrill and mild coughing. Thoracic auscultation revealed a grade V/VI systolic murmur with maximal intensity over the left apex characterized by musical murmur. Echocardiography revealed mild myxomatous degeneration of mitral valve and ruptured chordae tendineae. Musical murmur was produced due to the vibration of ruptured piece of chordae tendineae along with regurgitant flow. After treatment with furosemide and ramipril, clinical signs resolved and precordial thrill reduced. This case report describes typical clinical signs and phonocardiogram of musical murmur in a dog with acute chordae tendineae rupture.
Animals ; Auscultation ; Child ; Chordae Tendineae* ; Cough ; Dogs* ; Echocardiography ; Female ; Furosemide ; Humans ; Mitral Valve ; Music* ; Ramipril ; Rupture* ; Systolic Murmurs ; Vibration

Aged ; Angioplasty, Balloon, Coronary ; Heart Rupture, Post-Infarction ; complications ; diagnostic imaging ; Humans ; Male ; Myocardial Infarction ; therapy ; Papillary Muscles ; Shock, Cardiogenic ; etiology ; Systolic Murmurs ; etiology ; Ultrasonography

We report three cases of iron deficiency anemia due to long-time bloodletting using cupping. Case 1 was a 52-year-old man who sought evaluation at the Health Promotion Center in our hospital due to fatigue and dyspnea on exertion (DOE). There were no abnormal findings on his general health examination, except anemia. He has performed self-bloodletting for a long time with cupping on his back and extremities for fatigue, myalgias, or polyarthralgias. Case 2 was a 52-year-old woman with fatigue and DOE. The physical examination revealed a systolic murmur at her left lower anterior chest and pale conjunctiva. The initial hematocrit was 22.4% and the hemoglobin was 6.4 g/dL. She has self-bloodletted using cupping 2 to 3 times a week when she felt tired or had myalgias. Case 3 was a 35-year-old man with sudden onset fatigue and DOE. He had severe DOE during a challenging physical test. He frequently received bloodletting using cuppings on his back and extremities by a doctor of Oriental medicine. There were no abnormal findings on the general health examination, except anemia. All three patients were diagnosed with iron deficiency anemia due to chronic blood loss. We recommended stopping bloodletting using cupping and prescribed oral iron supplements.
Adult ; Anemia ; Anemia, Iron-Deficiency ; Arthralgia ; Bloodletting ; Conjunctiva ; Dyspnea ; Extremities ; Fatigue ; Female ; Health Promotion ; Hematocrit ; Hemoglobins ; Humans ; Iron ; Medicine, East Asian Traditional ; Middle Aged ; Physical Examination ; Systolic Murmurs ; Thorax

A 47-year-old woman was admitted for evaluation of exertional dyspnea (NYHA II-III) that was lasting for 20 years. On physical examination, a grade III systolic murmur in the left second intercostal spaces was detected. The chest Xray showed mild cardiomegaly. ECG showed biatrial and biventricular hypertrophy. Transthoracic echocardiography showed severe infundibular pulmonic stenosis (pressure gradient=174 mmHg), moderate tricuspid regurgitation (jet velocity=6.6 m/sec) with biatrial enlargement and biventricular hypertrophy. Transesophageal echocardiogram showed severe infundibular pulmonic stenosis. Right ventriculography and catheterization revealed a pressure gradient between pulmonary artery and right ventricle (178/6 mmHg). We reported a rare case of infundibular pulmonic stenosis with intact ventricular septum in adult with literatures.
Adult* ; Cardiomegaly ; Catheterization ; Catheters ; Dyspnea ; Echocardiography ; Electrocardiography ; Female ; Heart Ventricles ; Humans ; Hypertrophy ; Middle Aged ; Physical Examination ; Pulmonary Artery ; Pulmonary Valve Stenosis* ; Systolic Murmurs ; Thorax ; Tricuspid Valve Insufficiency ; Ventricular Septum

An 82-year-old female non-smoker with a history of hypertension presented with increasing dyspnea, cough and some purulent sputum without fever. Upon admission, the patient was in a distressed condition. Auscultation revealed diminished breath sounds with no rales over the right lung. An examination of the heart revealed a regular rhythm and a systolic murmur radiating from the apex of the heart. There was no pitting edema in the lower extremities. The blood tests showed mild leukocytosis and an increased C-reactive protein level. The O2 saturation was 98 % whilst breathing room air. The electrocardiogram demonstrated sinus tachycardia. The chest radiograph showed a moderate cardiomegaly, right lobe infiltrates, and blunting of the both costophrenic sulcus suggesting a small pleural effusion. Three days after admission, the symptoms became slightly aggravated despite being treated with empirical antibiotics for presumed community-acquired pneumonia. Transthoracic color Doppler echocardiography indicated an ejection fraction of 48 %, mild left ventricular enlargement, and moderate left atrial enlargement resulting in severe mitral regurgitation. The clinical symptoms and right pulmonary edema resolved quickly with intravenous furosemide treatment.
Aged, 80 and over ; Anti-Bacterial Agents ; Auscultation ; C-Reactive Protein ; Cardiomegaly ; Cough ; Dyspnea ; Echocardiography, Doppler, Color ; Edema ; Electrocardiography ; Female ; Fever ; Furosemide ; Heart ; Hematologic Tests ; Humans ; Hypertension ; Leukocytosis ; Lower Extremity ; Lung ; Mitral Valve Insufficiency* ; Pleural Effusion ; Pneumonia ; Pulmonary Edema* ; Radiography, Thoracic ; Respiration ; Respiratory Sounds ; Sputum ; Systolic Murmurs ; Tachycardia, Sinus

The routine evaluation of coronary artery disease should include a history that obtains data on the charactor of pain, age, associated symptoms, and past history. The physical examination should include vital signs, a cardiovascular and pulmonary examination. The initial resting ECG plays a central role. Exercise ECG is an appropriate first-line test for patients with an intermediate probability of coronary artery disease. Echocardiogram is as a routine test for diagnosis of the case of acute chest pain especially in patients with a systolic murmur or regional wall motion almormality. Imaging during physical or pharmacological stress is considered to be appropriate in patients for whom exercise ECG is unlikely to be useful because of baseline ECG abnormalities. Pharmacological stress with adenosine or dipyridamole is appropriate for patients who are unable to exercise. Coronary angiography is not considered clearly appropriate as routine test for diagnosis of chronic stable angina in most patients except for those who had survived sudden cardiac death. But it is considered appropriate for diagnosis of angina whose diagonsis is still uncertain after noninsasive testing. Cardiac troponin is as a preferred marker for acute ischemic injury. Biochemical cardiac markers should be performed for all patients with suspected acute myocardial infarction.
Adenosine ; Angina, Stable ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Death, Sudden, Cardiac ; Diagnosis* ; Dipyridamole ; Electrocardiography ; Humans ; Myocardial Infarction ; Physical Examination ; Systolic Murmurs ; Troponin I ; Vital Signs