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Our aim was to investigate the ability of an artificial intelligence (AI)-based algorithm to differentiate innocent murmurs from pathologic ones. An AI-based algorithm was developed using heart sound recordings collected from 1413 patients at the five university hospitals in Finland. The corresponding heart condition was verified using echocardiography. In the second phase of the study, patients referred to Helsinki New Children's Hospital due to a heart murmur were prospectively assessed with the algorithm, and then the results were compared with echocardiography findings. Ninety-eight children were included in this prospective study. The algorithm classified 72 (73%) of the heart sounds as normal and 26 (27%) as abnormal. Echocardiography was normal in 63 (64%) children and abnormal in 35 (36%). The algorithm recognized abnormal heart sounds in 24 of 35 children with abnormal echocardiography and normal heart sounds with normal echocardiography in 61 of 63 children. When the murmur was audible, the sensitivity and specificity of the algorithm were 83% (24/29) (confidence interval (CI) 64–94%) and 97% (59/61) (CI 89–100%), respectively. Conclusion: The algorithm was able to distinguish murmurs associated with structural cardiac anomalies from innocent murmurs with good sensitivity and specificity. The algorithm was unable to identify heart defects that did not cause a murmur. Further research is needed on the use of the algorithm in screening for heart murmurs in primary health care. What is Known: • Innocent murmurs are common in children, while the incidence of moderate or severe congenital heart defects is low. Auscultation plays a significant role in assessing the need for further examinations of the murmur. The ability to differentiate innocent murmurs from those related to congenital heart defects requires clinical experience on the part of general practitioners. No AI-based auscultation algorithms have been systematically implemented in primary health care. What is New: • We developed an AI-based algorithm using a large dataset of sound samples validated by echocardiography. The algorithm performed well in recognizing pathological and innocent murmurs in children from different age groups. [ABSTRACT FROM AUTHOR]

Background Objectives Animals Methods Results Conclusion and Clinical Importance The presence and intensity of heart murmurs are sensitive indicators of several cardiac diseases in dogs, particularly myxomatous mitral valve disease (MMVD), but accurate interpretation requires substantial clinical expertise.Assess if a machine‐learning algorithm can be trained to accurately detect and grade heart murmurs in dogs and detect cardiac disease in electronic stethoscope recordings.Dogs (n = 756) with and without cardiac disease attending referral centers in the United Kingdom.All dogs received full physical and echocardiographic examinations by a cardiologist to grade any murmurs and identify cardiac disease. A recurrent neural network algorithm, originally trained for heart murmur detection in humans, was fine‐tuned on a subset of the dog data to predict the cardiologist's murmur grade from the audio recordings.The algorithm detected murmurs of any grade with a sensitivity of 87.9% (95% confidence interval [CI], 83.8%‐92.1%) and a specificity of 81.7% (95% CI, 72.8%‐89.0%). The predicted grade exactly matched the cardiologist's grade in 57.0% of recordings (95% CI, 52.8%‐61.0%). The algorithm's prediction of loud or thrilling murmurs effectively differentiated between stage B1 and B2 preclinical MMVD (area under the curve [AUC], 0.861; 95% CI, 0.791‐0.922), with a sensitivity of 81.4% (95% CI, 68.3%‐93.3%) and a specificity of 73.9% (95% CI, 61.5%‐84.9%).A machine‐learning algorithm trained on humans can be successfully adapted to grade heart murmurs in dogs caused by common cardiac diseases, and assist in differentiating preclinical MMVD. The model is a promising tool to enable accurate, low‐cost screening in primary care. [ABSTRACT FROM AUTHOR]

The article focuses on an 11-year-old boy presenting with slurred speech and involuntary movements, later diagnosed with a neurological disorder. Topics include his clinical symptoms such as dysarthria and abnormal involuntary movements, his physical exam findings including hyperreflexia and abnormal gait, and the absence of significant prior medical or family history.

Simple Summary: Infective endocarditis represents a rare, acquired condition in animals, but also in humans, that typically involves one of the heart valves and mainly affecting the mitral and aortic valves in dogs. This report describes the clinical signs, the diagnostic approach and the postmortem investigations of a case confirmed with infective endocarditis at the level of the aortic valve but also the presence of a main consequence of the disease, represented by the development of paravalvular abscesses and subsequent fistulous tracts between heart chambers. Infective endocarditis is a severe but rarely diagnosed disease, characterized by the presence of bacterial infection at the level of the cardiac valves. Although the incidence of the disease is very low, the consequences are severe and the prognosis is very poor, outlining a high mortality rate among cases. The present report highlights the case of a 7-year-old dog presented with abrupt changes in the respiratory pattern, obtunded and in lateral recumbency. The physical examination of the patient revealed fever and a IV/VI systolic heart murmur, with the point of maximal intensity on the left hemithorax. Echocardiography identified hyperechoic and cavitary changes beneath the aortic valves and a retrograde turbulent jet originating in the left ventricle outflow tract communicating with the left atrium through a rupture in the aortomitral intervalvular wall. Because of very unstable hemodynamic changes, the dog suddenly died despite the initiation of intensive care supportive treatment, and the postmortem evaluation of the heart confirms the suspicion of infective aortic endocarditis with the development of a paravalvular abscess and an aorto-left atrial fistula. [ABSTRACT FROM AUTHOR]

A 12‐year‐old female spayed Domestic Shorthair cat presented with a 4‐day history of lethargy, inappetence and vomiting. Physical findings included a grade 2/6 heart murmur and cranial abdominal pain on palpation. Serum biochemistry revealed elevated total bilirubin and liver enzymes activities. Abdominal ultrasound revealed multiple pancreatoliths, cholelithiasis and dilation of the pancreatic duct. During exploratory laparotomy, catheterisation of the pancreatic duct with retrograde and orthograde flushing to remove the pancreatoliths was performed via a distal enterotomy and proximal left apical partial pancreatectomy respectively. Catheterisation and flushing of the common bile duct were performed to confirm patency prior to cholecystectomy. Bacterial culture of pancreatoliths, pancreatic tissue and bile grew a heavy, pure growth of Providencia rettgeri. Fluorescent immunostaining histopathology revealed clusters of rod‐shaped bacteria within the pancreatic parenchyma and gall bladder mucosa. The cat received pradofloxacin for two weeks. She made a complete recovery and remained well at a six‐month follow‐up. [ABSTRACT FROM AUTHOR]

Computerized evaluation of valve anomalies from cardiac sound is a well-tried endeavor in cardiology. Conversely, automated methods for the diagnosis of cardiovascular diseases mainly depend on the features collected from the cardiac signal. Analyzing phonocardiogram (PCG) signals can yield useful information into the mechanics of the heart. A machine learning technique for detecting and classifying murmurs is proposed, which takes into account the statistically significant features derived from comparing spectrogram images obtained by the Short-Time Fourier Transform (STFT) of the PCG signals. The spectrograms are compared by Peak Signal-to-Noise Ratio (PSNR) and Structural Similarity Index Matrix (SSIM). Finally, these similarity index features are fed into various decision trees, both with and without PCA to classify like normal heart sound and murmurs like systolic, diastolic, and continuous. The SSIM and PSNR alone offer accuracy of 88.23% and 87.94%, respectively for distinguishing normal and murmur and are differ with a P-value of 2.05 × 10−19. The PCA enabled coarse tree performs better in terms of classification accuracy of 85% and 92.50% during training and testing, respectively. The results show that this method can accurately detect and classify heart murmurs, outperforming conventional methods. [ABSTRACT FROM AUTHOR]

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AbstractIntroductionMethodsResultsConclusionInfective endocarditis (IE) is a challenging diagnosis to suspect and to confirm. The purpose of this study was to clarify how often IE is suspected already on hospital admission, which clinical signs trigger the physicians’ suspicions and to investigate if the empirical treatment is adequate.A retrospective observational study of cases with definitive IE, during 2018–2019 in Skåne Region, Sweden was performed. Cases were identified by ICD-codes for IE and medical records were reviewed to reveal if IE was suspected at hospital admission and if empirical treatment was adequate.Of 156 episodes with definitive IE, suspicion of IE arose on admission in 36 (23%) of the cases. A longer symptom duration, heart murmurs, male sex, and lower age were significantly more common in the group where IE was suspected. In the 118 cases where empirical antibiotic treatment was initiated, 98 (83%) got an adequate empirical treatment while in 16 (14%) of the cases the organism identified was resistant. IE-directed treatment was achieved significantly earlier in the suspicion group, median of 1 day, compared to a median of 2 days (p < 0.0001) when endocarditis was not initially suspected.IE is suspected already upon admission mainly in cases with a subacute presentation. Increased knowledge of IE with acute presentation could possibly result in earlier diagnosis and correct IE-directed treatment. The clinical impact of this is uncertain since most cases still were treated with adequate empirical antibiotics. [ABSTRACT FROM AUTHOR]

Canine protothecosis is a rare disease caused by saprophytic unicellular achlorophyllous aerobic algae that are ubiquitous in the environment. We report a novel case of neurological and cardiological manifestations associated with disseminated protothecosis. An adult spayed female Boxer dog was presented with a 1‐week history of anorexia, progressive central vestibular signs, and a Grade III/VI systolic heart murmur. Magnetic resonance (MR) imaging revealed obstructive hydrocephalus at the level of the mesencephalic aqueduct, while echocardiography and elevated troponin levels suggested an infiltrative cardiomyopathy. No obvious cause was identified. Cerebrospinal fluid (CSF) collection was not performed due to associated procedural risks. Despite receiving symptomatic treatment and maintaining stability for 3 weeks, the dog eventually suffered cardiorespiratory arrest. Postmortem examination revealed disseminated protothecosis, predominantly affecting the heart and brain. We recommend that in cases where the cause of obstructive hydrocephalus is unclear, especially when CSF collection is not feasible, a comprehensive diagnostic method should be implemented. This includes meticulous investigations to identify infected tissues, followed by sampling and performing cytology/histology and culture tests to confirm the presence of the algal organism. Early diagnosis may allow early treatment, although long‐term prognosis remains largely unfavorable due to the absence of effective treatments. [ABSTRACT FROM AUTHOR]

Heart murmurs play a critical role in assessing the condition of the heart. Murmur quality reflects the subjective human perception of heart murmurs and is an important characteristic strongly linked to cardiovascular diseases (CVDs). This study aims to use deep neural networks to classify the patients' murmur quality (i.e., harsh and blowing) from phonocardiogram (PCG) signals. The phonocardiogram recordings with murmurs used for this task are from the CirCor DigiScope Phonocardiogram dataset, which provides the murmur quality labels. The recordings were segmented, and a dataset of 1266 segments with average lengths of 4.1 s from 164 patients' recordings was obtained. Each patient usually has multiple segments. A deep neural network model based on convolutional neural networks (CNNs) with channel attention and gated recurrent unit (GRU) networks was first used to extract features from the log-Mel spectrograms of segments. Then, the features of different segments from one patient were weighted by the proposed "Feature Attention" module based on the attention mechanism. The "Feature Attention" module contains a layer of global pooling and two fully connected layers. Through it, the different features can learn their weight, which can help the deep learning model distinguish the importance of different features of one patient. Finally, the detection results were produced. The cross-entropy loss function was used to train the model, and five-fold cross-validation was employed to evaluate the performance of the proposed methods. The accuracy of detecting the quality of patients' murmurs is 73.6%. The F1-scores (precision and recall) for the murmurs of harsh and blowing are 76.8% (73.0%, 83.0%) and 67.8% (76.0%, 63.3%), respectively. The proposed methods have been thoroughly evaluated and have the potential to assist physicians with the diagnosis of cardiovascular diseases as well as explore the relationship between murmur quality and cardiovascular diseases in depth. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is a leading global cause of mortality. Most stethoscopes still necessitate the use of tubing, which entails direct physical contact between the healthcare provider and patient. The stethoscope can serve as a means of transmission if it is utilized on individuals who have been diagnosed with airborne and droplet-borne infectious illnesses. A prototype was created to capture heart sounds using a Phonocardiography (PCG) device over website-based Bluetooth connectivity. This approach offers the benefits of being cost-effective, facilitating computer-aided diagnostics, and being wearable. In addition, the primary significance of this study resides in the identification of heart sound irregularities caused by cardio dynamic abnormalities of the heart valves, known as murmurs. The heart sound categorization process utilizes a machine learning model that involves extracting 25 Mel frequency cepstral coefficients (MFCC) as features. The model employs a hybrid approach combining convolutional neural network and long short-term memory (CNN-LSTM) techniques. The research findings indicate that the suggested model achieves an average accuracy rate of 95.9% over five distinct categories, i.e., normal, atrial stenosis, mitral regurgitation, mitral stenosis, and mitral valves prolapse. Further study can be conducted on hardware development by incorporating an infrared sensor at the fingertip of the stethoscope. [ABSTRACT FROM AUTHOR]

Background: Carcinoid tumors are rare neuroendocrine malignancies presenting in an increasing number in our center. The incidence of carcinoid tumors is approximatively between 2.5 and 5 cases per 100,000 people of whom about 50% develop carcinoid syndrome. Once the carcinoid syndrome has developed, a carcinoid cardiomyopathy can occur. Carcinoid heart disease (CaHD) remains a serious and rare complication associated with a significant increase in morbidity and mortality. Although carcinoid tumors have been known and studied for several years, there are still scarce data on the anesthetic management and the peri operative period. Case presentation: We describe a case of a Caucasian 44-year-old woman with an unusual presentation of left CaHD with an ileal neuroendocrine tumor and liver metastases. Our preoperative somatostatin administration protocol, limit the cardiac damage. The maintenance of stable hemodynamics, the use of balanced anesthetic technique, all along with a good understanding of the pathology, played a major role in the successful management of anesthesia. This case report allows us to introduce our decision algorithm for the management of this type of pathology in our tertiary hospital, Cliniques Universitaires Saint-Luc. Conclusion: Despite the paucity of data, anesthetic management of patients with carcinoid tumor can be safely performed with effective hemodynamic monitoring and a good understanding of the pathophysiology. Knowledge and application of a clear institutional algorithm for octreotide administration and multidisciplinary consultation at a referral center are essential for the management of these patients. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Ruptured sinus of Valsalva (RSOV) upon physical exertion is rare but should be considered in differential in young adults. Symptoms of acute heart failure, hemodynamic instability, and continuous heart murmur raises suspicion for RSOV and requires emergent surgical repair of right ventricular outflow tract. [ABSTRACT FROM AUTHOR]

Introduction. In Poland, interventions of emergency medical teams in patients with malignant tumors represent a small percentage of all interventions. Patients with malignant tumors constitute a diverse group in which the patient may manifest a wide spectrum of symptoms and complaints affecting different systems and organs. The aim of this study was to retrospectively analyze emergency medical team interventions in patients with malignant tumors. Material and methods. 1174 emergency medical services forms from emergency medical team interventions in patients with malignant tumors from April 2019 to December 2022 in the Kujawsko-Pomorskie voivodship in Poland were analyzed. Results. In the study group 52% were male. The mean age of the subjects was 66 years (SD = 12.31). The most common symptoms in patients were pathological respiratory murmurs (11.7%), psychomotor disorders (11.3%), hypoxemia (10.3%), dyspnea (9.5%) and pain (5.8%). 40.5% of patients were transported to hospital. A total of 7496 emergency medical procedures were performed, most of them involving physical examination and assessment of the patient's condition. The pharmacotherapy administered most commonly involved analgesics (30.9%), electrolytes (24%) and glucocorticosteroids (20.1%). Seventy-four patients (6.3%) died during EMT intervention. Conclusions. Emergency medical teams most often provide assistance to patients with malignant tumors of the respiratory and thoracic organs and organs of the digestive system. The majority of oncology patients do not require hospital treatment, but only outpatient care. Therefore, there is a need to regulate and optimize the actions taken by emergency medical teams when intervening in patients with malignant tumors. [ABSTRACT FROM AUTHOR]

Background: Approximately 50% of children experience a cardiac murmur at some point in their lives; <1% of these murmurs are attributed to congenital heart disease (CHD). Cardiac murmur might be the first clinical sign of a significant CHD in children. Despite careful routine medical examinations at birth, approximately 50% of CHD cases could remain unrecognised. Objective: Cardiovascular symptoms and signs could be specific or non-specific in neonates and children with heart murmurs. Knowledge about red flags in history and physical examinations, and syndromic associations of common CHDs are important. Auscultatory skills to identify systolic, diastolic and continuous murmurs and heart sounds are essential. Differential diagnosis should be formulated based on the location of maximum intensity of murmurs. Younger infants and children with pathological murmurs and red-flag signs should be promptly referred to local paediatric cardiology services for further investigations. Discussion: Significant skill and knowledge are required for the identification of critical murmurs and associated cardiovascular problems. This review provides a simplified comprehensive update on cardiac murmurs and associated conditions in neonates and children. [ABSTRACT FROM AUTHOR]

Simple Summary: Screening puppies carefully for heart murmurs during the first veterinary health visit is essential to disclose hidden congenital heart diseases. However, murmurs in puppies can also be innocent. Ideally, puppies with a possible congenital heart disease should not be sold to a new owner by their breeders. Our study aimed to investigate how easy veterinarians find differentiating innocent from pathologic murmurs, and how they manage puppies with a pathological murmur. We sent a questionnaire to veterinary practices in the Netherlands and Belgium, and analyzed 452 responses. Though 88% of the respondents find detecting a heart murmur easy, only 9% find differentiating innocent from pathologic murmurs in puppies easy. Only 80% of veterinarians recommend immediate referral of puppies with a pathologic heart murmur. Most respondents recognize that normal growth and lack of clinical signs do not rule out congenital heart disease. Though there are several centers with a veterinary cardiology specialist employed in the surveyed countries, only 43% of the respondents recommended the referral of a puppy to a veterinary cardiology specialist for murmur investigation. In conclusion, most veterinarians understand the importance of an echocardiography of puppies with loud murmurs, but they acknowledge the difficulty in distinguishing innocent from pathological murmurs. Background: Heart murmurs in puppies can be innocent or pathologic; the latter is almost always related to a congenital heart disease. Differentiating between these murmurs can be challenging for practicing veterinarians, but this differentiation is essential to ensure the best prognosis for puppies having a congenital heart disease. Our study aimed to reveal how veterinarians manage puppies with a heart murmur. Methods: A web-based questionnaire was sent to Dutch and Belgian veterinary practices. Results: Data from 452 respondents were analyzed. Though 88% of the respondents find detecting a heart murmur easy, only 9% find differentiating innocent murmurs from pathologic murmurs in puppies easy. Of the respondents, only 80% recommend immediate additional examination when detecting a loud heart murmur during the first veterinary health check at 6 weeks of age. Most of the respondents are aware that normal growth and the absence of clinical signs do not exclude severe congenital heart disease. Of the respondents, 31% were uncertain whether early surgical intervention could lead to improved outcomes. Conclusions: Veterinarians are aware of the importance of echocardiography for puppies with a loud heart murmur, and recognize their limitations when differentiating an innocent from a pathological heart murmur in a puppy. [ABSTRACT FROM AUTHOR]

Background: Congenital absence of pericardium is a rare cardiac disorder with a reported incidence of less than 1 in 10,000. Although most of the cases are of little clinical significance, some of them are associated with serious complications, including risk of herniation and strangulation or coronary artery compression. Detailed Case Description: We report a case of a 36-year-old male referred for routine cardiovascular examination. He had a medical history of a heart murmur since childhood. Electrocardiogram (ECG) revealed sinus rhythm, normal axis, poor R-wave progression in the precordial leads and repolarization abnormalities with negative T waves in leads V1–V4. On 2D transthoracic echocardiography (TTE), an unusual heart position was noted with poor image quality from the standard acoustic windows. The parasternal long axis view gave the impression of right ventricular dilatation. The findings raised the suspicion of left to right shunt and possible atrial septal defect. For further evaluation, the patient was referred for cardiac magnetic resonance which demonstrated complete left-sided absence of the pericardium. Discussion: Due to indistinct and atypical symptoms and lack of clinical awareness, pericardial congenital absence is frequently misdiagnosed. Patients may complain of atypical chest pain. Patient's history and physical examination are often nonspecific. In cases with complete pericardial absence, ECG findings may include right axis deviation, right bundle block and sinus bradycardia. Echocardiography findings are also not characteristic, but some may raise the clinical suspicion of this diagnosis. The imaging modalities of choice are computed tomography and cardiac magnetic resonance. Treatment depends on the type of defect and clinical symptoms. [ABSTRACT FROM AUTHOR]

Heart diseases have a great impact on human health. Heart sound signals contain a lot of useful information about heart diseases. Therefore, various heart diseases can be judged by heart sound auscultation. In order to improve the accuracy of classification and judgment, a heart sound signal classification method based on the mixed characteristics of Mel cepstrum coefficient and second-order spectrum is proposed: first, a class of normal heart sounds and aortic stenosis, mitral regurgitation, mitral stenosis, mitral valve prolapse. The Mel cepstrum coefficients and second-order spectral features of four kinds of abnormal heart sounds with mitral valve prolapse are extracted separately and then combined into a new feature. The convolution neural network is used for learning and classification. The whole data set has a total of 1000 audio records, which are randomly divided into test sets and training sets by 2:3. From the experimental results, it can be seen that the accuracy rate in the training set is 99.6%, and the accuracy rate in the test set is 98.5%. Compared with other traditional classification and recognition methods, the accuracy is significantly improved. [ABSTRACT FROM AUTHOR]

Infective endocarditis is a relatively common cardiac infection with variable clinical presentations. The main symptoms of fever, dyspnea and cough can be easily confused with COVID-19 infection. Cardiac murmurs are present in 85% of patients with infective endocarditis, and a thorough physical examination is essential to aid in the diagnosis. This case report describes the clinical history of a 65-year-old male presented with flu like symptoms and admitted to the quarantine ward due to a suspected COVID-19 infection. Prior to his hospital discharge he had a sudden deterioration and turned out to have infective endocarditis, with severe mitral regurgitation requiring an emergency mitral valve replacement surgery. This case demonstrates the importance of considering other life-threatening infections during a global pandemic like COVID-19. A comprehensive physical examination should be thoroughly performed to avoid missing alternative serious diagnoses. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most common sustained supraventricular arrhythmia encountered in clinical practice. Due to the higher prevalence of rheumatic fever in several regions of India, rheumatic heart disease (RHD) is the most common etiological factor of AF. Aims and Objectives: The objective of the study was to study clinical features, electrocardiographic (ECG) and echocardiographic (ECHO) findings, complications, and incidence of AF in rheumatic mitral valve disease (R-MVD). Methods: It is an observational cross-sectional study of 40 indoor patients in a Tertiary Care Hospital in Vadodara, Gujarat, carried over a period of a year. Clinical data including symptoms, signs, systemic examination, and relevant investigations were studied. Results: 67.5% (n = 27) of patients having AF were below the age of 50 years with higher incidence among females (72.50%) as compared to males (27.5%). Fifteen (37.5%) had mitral stenosis (MS) and 13 (32.5%) had MS with regurgitation. Most of the patients 35 (87.5%) presented with breathlessness, followed by palpitation 28 (70%). The most commonly heard murmur was mid-diastolic (65%, n = 26), followed by pansystolic murmur (40%, n = 16) at the apex. Out of 40 patients, 15 (37.5%) had evidence of left ventricular hypertrophy on ECG, whereas only 5 (12.5%) had right ventricular hypertrophy. Four out of five patients with the evidence of cardioembolic stroke had left atrium (LA) size >45 mm which suggests an increased risk of embolic stroke with increased LA size. Only 3 (7.5%) patients had a visible LA clot in LA on two-dimensional ECHO, whereas only one patient had vegetation on valves. Twenty-seven out of 30 patients treated with diltiazem show good response. Heart failure was the most common complication affecting 85% (n = 34) of the patients with AF with R-MVD. Four (10%) patients out of 40 expired including 1 (25%) of the four pregnant patients, suggesting higher mortality among pregnant females due to superimposed physiological changes occurring during pregnancy. Conclusion: In developing countries like India, RHD is a major cause of AF affecting the younger population and more commonly females. Most of the patients in our study presented with breathlessness and palpitation. LA size was directly proportional to the risk of cardioembolic stroke and most of the patients developed heart failure as a complication. [ABSTRACT FROM AUTHOR]

Background. Our knowledge regarding the epidemiology of pediatric cardiomyopathy is based on large national population studies reporting an annual incidence of 1 case per 100,000 children, with a higher incidence observed in infancy and among selected populations. The aim here is to document the epidemiology of pediatric cardiomyopathy in a Mediterranean population. Methods. Children younger than 18 years of age living on the Mediterranean island of Crete, Greece, who have been evaluated since the establishment of tertiary pediatric cardiology services (2002–2022) were included in this retrospective study. Results. A total of 40 children were included, corresponding to an average annual incidence of pediatric cardiomyopathy of 1.59 cases (95% CI: 1.4–2.3) and a prevalence of 26 cases per 100,000 children. In decreasing order of frequency, most cases corresponded to dilated (50%), followed by hypertrophic (42.5%), arrhythmogenic (5%), and restrictive (2.5%) cardiomyopathy. An etiology was identified in 40%, including a genetic diagnosis in 22.5%. Conclusions. The incidence of pediatric cardiomyopathy in the Mediterranean island of Crete is higher compared with that reported previously for other Caucasian populations. Further study is needed to investigate the exact prevalence and specific genetic factors associated with the epidemiology of pediatric cardiomyopathy in Mediterranean populations. [ABSTRACT FROM AUTHOR]

Cor triatriatum is a rare congenital heart defect in which a thin, fibro-muscular membrane divides the left or right atrium into two chambers resulting in a triatrial heart. Subdivision of the left atrium named cor triatriatum sinister (CTS), is the more common form, whereas the right atrial equivalent called cor triatriatum dexter (CTD) is rarer. They account for up to 0.4% and 0.025% of the burden of congenital heart disease respectively. We present the case of CTD found incidentally with transthoracic echocardiography for a patient who underwent aortic valve replacement for symptomatic bicuspid aortic valve stenosis. [ABSTRACT FROM AUTHOR]

Sudden cardiac death in children is a rare event, but of great social significance. Generally, it is related to heart disease with a risk of sudden cardiac death (SCD), which may occur with cardiovascular symptoms and/or electrocardiographic markers; thus, a primary care paediatrician (PCP) could detect them. Therefore, we proposed a study that assesses how to put into practice and conduct a cardiovascular assessment within the routine healthy-child check-ups at six and twelve years of age; that reflects cardiovascular signs and symptoms, as well as the electrocardiographic alterations that children with a risk of SCD in the selected population present; and that assesses the PCP's skill at electrocardiogram (ECG) interpretation. In collaboration with PCPs, primary care nurses, and paediatric cardiologists, an observational, descriptive, multicentre, cross-sectional study was carried out in the Balearic Islands (Spain), from April 2021 to January 2022, inclusive. The PCPs gathered patient data through forms (medical record, electrocardiogram, and physical examination) and sent them to the investigator, together with the informed consent document and electrocardiogram. The investigator passed the electrocardiogram on to the paediatric cardiologists for reading, in an identical form to those the paediatricians had filled in. The variables were collected, and a descriptive analysis performed. Three paediatric cardiologists, twelve PCPs, and nine nurses from seven public health centres took part. They collected the data from 641 patients, but 233 patients did not participate (in 81.11% due to the PCP's workload). Therefore, the study coverage was around 64%, representing the quotient of the total number of patients who participated, divided by the total number of patients who were eligible for the study. We detected 30 patients with electrocardiographic alterations compatible with SCD risk. Nine of these had been examined by a paediatric cardiologist at some time (functional murmur in 8/9), five had reported shortness of breath with exercise, and four had reported a family history of sudden death. The physical examination of all the patients whose ECG was compatible with a risk of SCD was normal. Upon analysing to what extent the ECG results of the PCP and the paediatric cardiologist agreed, the percentage of agreement in the final interpretation (normal/altered) was 91.9%, while Cohen's kappa coefficient was 31.2% (CI 95%: 13.8–48.6%). The sensitivity of the ECG interpretation by the PCP to detect an ECG compatible with a risk of SCD was 29% and the positive predictive value 45%. Conclusions: This study lays the foundations for future SCD risk screening in children, performed by PCPs. However, previously, it would be important to optimise their training in reading and interpreting paediatric ECGs. What is Known: • In Spain at present, there is a programme in place to detect heart disease with a risk of sudden death [1], but it targets only children who are starting on or are doing a physical activity as a federated sport. Implementing such screening programmes has proven effective in several countries [2]. However, several studies showed that the incidence of sudden cardiac death is no higher in children competing in sport activities than in those who do not do any sport [3]. This poses an ethical conflict, because at present, children who do not do any federated sport are excluded from screening. According to the revised literature, so far, only in two studies did they screen the child population at schools, and in both, they successfully detected patients with heart disease associated to the risk of sudden death [4-5]. We have found no studies where the screening of these features was included within the routine healthy-child check-ups by primary care paediatricians. What is New: • We did not know whether—in our setting, at present—the primary care paediatrician could perform a screening method within the routine healthy-child check-ups, in order to detect presumably healthy children at risk of sudden cardiac death, as they present one of the SCD risks. In this regard, we proposed our project: to assess how to put into practice and conduct a cardiovascular assessment via SCD risk screening in the healthy child population by primary care paediatricians and appraise primary care paediatricians' skills in identifying the electrocardiographic alterations associated with SCD risk. The ultimate intention of this pilot study was to make it possible, in the future, to design and justify a study aimed at universalising cardiovascular screening and achieving a long-term decrease in sudden cardiac death events in children. [ABSTRACT FROM AUTHOR]

Pediatric pial arteriovenous shunts in the brain and spine are challenging to understand because of low incidence, variable presentation, and associations with genetic syndromes. What is known about their natural history comes from reviews of small series. To better understand the natural history and role for intervention, two cases are presented followed by a review of the literature. In the first case, an infant with a prior history of intracranial hemorrhage from a ruptured pial fistula returns for elective embolization for a second pial fistula which was found to be spontaneously thrombosed 2 weeks later. In the second case, a 5-year-old with a vertebro-vertebral fistula, identified on work up for a heart murmur and documented with diagnostic angiography, is brought for elective embolization 6 weeks later where spontaneous thrombosis is identified. In reviewing the literature on pediatric single-hole fistulae of the brain and spine, the authors offer some morphologic considerations for identifying which high-flow fistulae may undergo spontaneous thrombosis to decrease the potentially unnecessary risk associated with interventions in small children. [ABSTRACT FROM AUTHOR]

Simple Summary: Veterinary students are required to determine an animal's heart rate and diagnose heart murmurs and arrhythmias by the time of graduation. Accurate assessment of the heart sounds of horses is considered as a day one clinical competency. Limited opportunities exist in the veterinary curriculum to develop these competencies, especially during COVID-19 times. This research aimed to determine if a multimodal learning resource consisting of diagrams, heart sound recordings and visual representation of the sounds would assist in the development of veterinary students' confidence and ability to recognize normal and abnormal heart sounds of horses. Students were invited to utilize the teaching resource and voluntarily complete surveys about their confidence in recognizing normal heart sounds as well as various murmurs and important arrhythmias of horses. The survey results were analyzed by qualitative and quantitative means. Over a two-year period, 231 fourth-year and 222 fifth-year veterinary students had access to the resource; 89 completed the initial survey and 57 completed a second survey after using the resource. Results confirmed that after access to the resource students' understanding and perception of their auscultation abilities improved. Auscultation of heart sounds is an important veterinary skill requiring an understanding of anatomy, physiology, pathophysiology and pattern recognition. This cross-sectional study was developed to evaluate a targeted, audio-visual training resource for veterinary students to improve their understanding and auscultation of common heart conditions in horses. Fourth- and fifth-year 2021 and 2022 Bachelor of Veterinary Science students at the University of Queensland (UQ) were provided the learning resource and surveyed via online pre- and post-intervention surveys. Results were quantitatively analyzed using descriptive statistics and Mann–Whitney U tests. Open-ended survey questions were qualitatively analyzed by thematic analysis and Leximancer™ Version 4 program software analysis. Over the two-year period, 231 fourth-year and 222 fifth-year veterinary students had access to the resource; 89 completed the pre-intervention survey and 57 completed the post-intervention survey. Quantitative results showed the resource helped students prepare for practicals and their perception of competency and confidence when auscultating equine cardiac sounds improved (p < 0.05). Compared to fifth-year students, fourth-year students felt less competent at identifying murmurs and arrythmias prior to accessing the learning resource (p < 0.05). Fourth-year and fifth-year students' familiarity with detection of murmurs improved after completing the learning resource (p < 0.001). Qualitative analysis demonstrated a limited number of opportunities to practice equine cardiac auscultation throughout the veterinary degree, especially during the COVID-19 pandemic, and that integrated audio-visual resources are an effective means of teaching auscultation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cardiac diseases are highly detrimental illnesses, responsible for approximately 32% of global mortality [1]. Early diagnosis and prompt treatment can reduce deaths caused by cardiac diseases. In paediatric patients, it is challenging for paediatricians to identify functional murmurs and pathological murmurs from heart sounds. OBJECTIVE: The study intends to develop a novel blended ensemble model using hybrid deep learning models and softmax regression to classify adult, and paediatric heart sounds into five distinct classes, distinguishing itself as a groundbreaking work in this domain. Furthermore, the research aims to create a comprehensive 5-class paediatric phonocardiogram (PCG) dataset. The dataset includes two critical pathological classes, namely atrial septal defects and ventricular septal defects, along with functional murmurs, pathological and normal heart sounds. METHODS: The work proposes a blended ensemble model (HbNet-Heartbeat Network) comprising two hybrid models, CNN-BiLSTM and CNN-LSTM, as base models and Softmax regression as meta-learner. HbNet leverages the strengths of base models and improves the overall PCG classification accuracy. Mel Frequency Cepstral Coefficients (MFCC) capture the crucial audio signal characteristics relevant to the classification. The amalgamation of these two deep learning structures enhances the precision and reliability of PCG classification, leading to improved diagnostic results. RESULTS: The HbNet model exhibited excellent results with an average accuracy of 99.72% and sensitivity of 99.3% on an adult dataset, surpassing all the existing state-of-the-art works. The researchers have validated the reliability of the HbNet model by testing it on a real-time paediatric dataset. The paediatric model's accuracy is 86.5%. HbNet detected functional murmur with 100% precision. CONCLUSION: The results indicate that the HbNet model exhibits a high level of efficacy in the early detection of cardiac disorders. Results also imply that HbNet has the potential to serve as a valuable tool for the development of decision-support systems that aid medical practitioners in confirming their diagnoses. This method makes it easier for medical professionals to diagnose and initiate prompt treatment while performing preliminary auscultation and reduces unnecessary echocardiograms. [ABSTRACT FROM AUTHOR]

This study aimed to assess physicians' approach to cardiac murmurs and their level of knowledge about this sign, which is a crucial finding in childhood cardiac anomalies. The study intended to include all family physicians in the Adıyaman province of Turkey, but ultimately 150 out of 210 physicians participated and was completed with a percentage response rate of 71%. Participants were asked about their approach to cardiac murmurs, answered knowledge questions, and completed a questionnaire on demographic characteristics. Subsequently, eight heart sounds were played, and participants were asked to identify the nature of each sound. Family medicine specialists (all scores were p < 0.001) and physicians who completed a pediatric internship lasting over a month (knowledge score p = 0.012, behavioral score p = 0.021, recording score p = 0.01) demonstrated significantly higher knowledge, approach, and recording scores. Age and years in the profession showed a negative correlation with recording scores. The study highlights the significant impact of various factors such as gender, specialization, internship duration, experience, and theoretical knowledge on the ability to recognize and approach cardiac murmurs. These findings underscore the importance of incorporating these factors into medical education and development programs, especially those aimed at improving cardiac examination skills. [ABSTRACT FROM AUTHOR]

Background Coronary cameral fistula is a rare diagnosis, which may be picked up incidentally on cardiac imaging. While majority of cases is asymptomatic, they can be complicated by myocardial ischaemia, arrhythmias, heart failure, infective endocarditis, and rarely rupture or thrombosis of the fistula leading to sudden death. Case summary A 73-year-old female presents with fever, lethargy, and examination finding of a continuous cardiac murmur. CT coronary angiogram confirmed the presence of a coronary cameral fistula, with an aneurysmal RCA seen arising from the right coronary sinus, following an extensive tortuous course wrapping around the heart, and terminating at the right atrium. While there was initial streptococcus bacteraemia identified on blood culture sampling, no obvious masses were detected on the valves, chambers, or along the course of the fistula. Over time, she develops anginal chest pain and heart failure symptoms, with progressive dilatation of the right ventricle and functional tricuspid regurgitation secondary to shunting of the fistula into the right chambers. Surgical intervention was then pursued and successfully addressed these complications. Discussion This case report highlights the importance of advanced imaging modalities for accurate diagnosis of coronary cameral fistulae, addressing late manifestations of the disease and the necessity for a collaborative, multidisciplinary approach in managing complex cardiac anomalies. [ABSTRACT FROM AUTHOR]

The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications. [ABSTRACT FROM AUTHOR]

In this case report, we present the unique and intriguing case of a 57-year-old man who experienced exertional palpitations and shortness of breath for 5 years. He was diagnosed with idiopathic heart failure three years ago, leading to diuretic treatment. Physical examination revealed notable left lower extremity swelling, severe varicose veins, and cardiac murmurs. Echocardiography showed significant cardiac enlargement and severe functional mitral and tricuspid valve regurgitation. Computed tomography (CT) imaging uncovered a 10 mm left common iliac arteriovenous fistula, causing abnormal early filling of the inferior vena cava (IVC) and marked IVC dilation. Open surgical repair of the arteriovenous fistula resulted in symptom relief and improved cardiac function. This case underscores the importance of considering unusual causes in heart failure patients and highlights the value of early diagnosis and intervention in complex cardiac-vascular interactions. [ABSTRACT FROM AUTHOR]

The phonocardiogram (PCG) signal is sometimes affected by added parameters that reflect the presence of a specific pathology. The intensity or the energy of the signal is one of the most reliable parameters when studying cardiac severity. Yet, in a pathological electrophysiological and audio signal, the severity information does not fully remain in the intensity or energy, but in other variables. In this paper, we will discuss the ability of a time-frequency parameter to discriminate, separate, and monitor the pathological cardiac severity levels. We studied 14 PCG signal from eight pathologies, six of them contain clicks (reduce murmurs), and eight murmur PCG signals with four different cardiac severity levels. We then calculated the entropy of approximation coefficients (EAC) from a discrete wavelet transform (DWT) analysis, to differentiate the PCG signals with clicks from those with murmurs and to assess the cardiac severity evolution. Since the entropy EAC is also related to the signal's intensity (energy), we compared it to the energetic ratio (ER) evolution, a parameter widely used for PCG signals discrimination and classification, which revealed that the EAC provied better results for the paper' purposes. [ABSTRACT FROM AUTHOR]

In summer 2023, during an outbreak of highly pathogenic avian influenza (HPAI) in cats in Poland, a 16-year-old dog was presented to the veterinary clinic with persistent, debilitating, dry cough, submandibular lymphadenomegaly, mild serous nasal discharge, and left apical heart murmur. A preliminary diagnosis of kennel cough was made and the treatment with amoxicillin/clavulanic acid and dexamethasone was initiated. Due to the lack of improvement within 2 days, a blood check-up, thoracic radiography and ultrasonography, and echocardiography were performed. Moreover, a rapid test for orthomyxovirus type A antigen in a throat swab was carried out and proved positive. The result was verified using RT-qPCR, which yielded a positive result for A/H5N1 influenza virus and negative results for A/H1N1, A/H3N2, type B influenza, and SARS-CoV-2. This case indicates that HPAI should be considered as a differential diagnosis not only in cats, but also in dogs with upper respiratory tract disease, particularly in regions experiencing A/H5N1 avian influenza outbreaks. [ABSTRACT FROM AUTHOR]

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital cardiac abnormality in which the pulmonary veins drain into the right atrium directly or the superior vena cava 90% of PAPVC are accompanied by atrial septal defect. However, PAPVC with ventricular septal defect is a rare entity. [ABSTRACT FROM AUTHOR]

Coronary artery aneurysms (CAAs) or ectasias are dilatations of arterial segments, commonly detected as an incidental finding during angiography. The incidence of CAAs varies from 0.3% to 5.3%, mainly caused by atherosclerosis, though infections, inflammatory conditions, and connective tissue disorders can also contribute. Giant CAAs are rare with a reported prevalence of 0.02-0.2%. In our case, a 45-year-old female has been diagnosed with a giant aneurysm in the right coronary artery, which was initially misinterpreted as a pericardial cyst. In addition, she has a bicuspid aortic valve and severe aortic stenosis, hence advised for surgical management. [ABSTRACT FROM AUTHOR]

Traditionally, heart murmurs are diagnosed through cardiac auscultation, which requires specialized training and experience. The purpose of this study is to predict patients' clinical outcomes (normal or abnormal) and identify the presence or absence of heart murmurs using phonocardiograms (PCGs) obtained at different auscultation points. A semi-supervised model tailored to PCG classification is introduced in this study, with the goal of improving performance using time–frequency deep features. The study begins by investigating the behavior of PCGs in the time–frequency domain, utilizing the Stockwell transform to convert the PCG signal into two-dimensional time–frequency maps (TFMs). A deep network named AlexNet is then used to derive deep feature sets from these TFMs. In feature reduction, redundancy is eliminated and the number of deep features is reduced to streamline the feature set. The effectiveness of the extracted features is evaluated using three different classifiers using the CinC/Physionet challenge 2022 dataset. For Task I, which focuses on heart murmur detection, the proposed approach achieved an average accuracy of 93%, sensitivity of 91%, and F1-score of 91%. According to Task II of the CinC/Physionet challenge 2022, the approach showed a clinical outcome cost of 5290, exceeding the benchmark set by leading methods in the challenge. [ABSTRACT FROM AUTHOR]

Objective: Heart murmurs in childhood are the most common reason for pediatric cardiology consultations worldwide. The aim of this study is to investigate the frequency and etiology of congenital heart disease (CHD) in two different centers possessing significant differences in factors such as geography, climate, and sociocultural conditions. Methods: The study involves patients who’d been referred to the pediatric cardiology outpatient clinic due to heart murmurs between November 2022-October 2023. All patients were evaluated by echocardiograph to investigate the causes of the murmur. Results: The study includes 2,127 patients (1,452 from Şırnak and 675 from Giresun; median age = 1.95 years). The gender distributions were similar in both regions. Pathological heart murmurs were more prevalent in Şırnak (21.6%) compared to Giresun (7.7%), while Giresun had a higher percentage of innocent murmurs (92.3%). Cyanotic conditions were rare. Surgery was required for 3.7% of patients overall (4.5% in Şırnak; 1.9% in Giresun). Normal echocardiograms were found in 46% of the total population, with variations being 41% in Şırnak and 56% in Giresun. Pathological murmurs were more common in females. Patients with pathological murmurs were more likely to require surgery. Şırnak had more pathological echocardiography results and a higher need for surgery. Neonates were the age group most frequently requiring surgery in both centers. Conclusions: Educating society and fostering awareness are imperative steps for preventing consanguineous marriages and encouraging appropriate birth intervals. Swift public education is particularly crucial in developing nations marked by elevated consanguinity rates and limited financial resources, highlighting the potential detrimental consequences of inbreeding. [ABSTRACT FROM AUTHOR]

OBJECTIVE To develop breed-specific echocardiographic values for normal Borzoi and to report the prevalence of structural cardiac abnormalities. ANIMALS 146 clinically healthy, adult Borzoi dogs. METHODS Cardiac auscultation and standard echocardiograms were performed. Longitudinal follow-up was described in a subset of dogs (n = 25). RESULTS Most Borzoi were structurally normal (119/146, 81.5%), with breed-specific echocardiographic values generated independently for each sex, as females weighed significantly less than males (30.4 ± 3.8 kg vs 38.3 ± 4.1 kg, respectively; P < .001), and a significant impact of sex was found on most measurements. Physiologic heart murmurs were identified in 64/119 (53.8%) normal dogs. Thirty-six (30.2%) structurally normal dogs had trace or mild mitral regurgitation, and 43 (36.1%) had trace or mild tricuspid regurgitation. Structural cardiac disease was identified in 21 dogs (14.4%), including 9 dogs (6.2%) with dilated cardiomyopathy (DCM), 9 dogs (6.2%) with stage B1 myxomatous mitral valve disease (MMVD), and 3 (2.1%) dogs with congenital abnormalities. Seven dogs (4.8%) had equivocal abnormalities. During follow-up, new dogs were diagnosed with occult DCM (n = 3), equivocal DCM (1), and stage B1 MMVD (2). Two dogs originally diagnosed with DCM (1 occult and 1 equivocal) normalized after diet change. CLINICAL RELEVANCE Borzoi dogs commonly have physiologic heart murmurs and mild atrioventricular valve regurgitation. Both DCM and MMVD were identified at similar frequencies in healthy Borzoi, although dogs with MMVD all had normal heart sizes. Echocardiographic screening for DCM in Borzoi should be considered, with breed-specific echocardiographic values now available for improved diagnostic confidence. [ABSTRACT FROM AUTHOR]

Simple Summary: Myxomatous mitral valve disease is dogs' most common acquired heart disease. The gold standard for its definitive diagnosis is echocardiography. This study aimed to develop a tool that uses a quality of life survey, structured anamnesis, and physical examination to predict the American College of Veterinary Internal Medicine classification stages. Accurately identifying a patient's stage is crucial to evaluating when treatment should be initiated and tailoring it to their ACVIM stage. The study analysed 1011 dogs from 23 hospitals, and the results showed that the majority of patients were successfully classified into the control group (healthy dogs), stage B (dogs with a heart murmur but are asymptomatic), and stage C (dogs with heart failure). However, efficient results were not obtained to differentiate between stage B1 (dogs with a heart murmur and without heart enlargement) and stage B2 (dogs with a heart murmur and heart enlargement). Further studies should be carried out to implement these techniques and improve their diagnostic value in veterinary cardiology. Myxomatous mitral valve disease (MMVD) is a prevalent canine cardiac disease typically diagnosed and classified using echocardiography. However, accessibility to this technique can be limited in first-opinion clinics. This study aimed to determine if machine learning techniques can classify MMVD according to the ACVIM classification (B1, B2, C, and D) through a structured anamnesis, quality of life survey, and physical examination. This report encompassed 23 veterinary hospitals and assessed 1011 dogs for MMVD using the FETCH-Q quality of life survey, clinical history, physical examination, and basic echocardiography. Employing a classification tree and a random forest analysis, the complex model accurately identified 96.9% of control group dogs, 49.8% of B1, 62.2% of B2, 77.2% of C, and 7.7% of D cases. To enhance clinical utility, a simplified model grouping B1 and B2 and C and D into categories B and CD improved accuracy rates to 90.8% for stage B, 73.4% for stages CD, and 93.8% for the control group. In conclusion, the current machine-learning technique was able to stage healthy dogs and dogs with MMVD classified into stages B and CD in the majority of dogs using quality of life surveys, medical history, and physical examinations. However, the technique faces difficulties differentiating between stages B1 and B2 and determining between advanced stages of the disease. [ABSTRACT FROM AUTHOR]

When uncertain, medical trainees often seek to co-regulate their learning with supervisors and peers. Evidence suggests they may enact self-regulated learning (SRL) strategies differently when engaged in self- versus co-regulated learning (Co-RL). We compared the impacts of SRL and Co-RL on trainees' acquisition, retention, and preparation for future learning (PFL) of cardiac auscultation skills during simulation-based training. In our two-arm, prospective, non-inferiority trial, we randomly assigned first- and second-year medical students to the SRL (N = 16) or Co-RL conditions (N = 16). Across two learning sessions separated by two-weeks, participants practiced and were assessed in diagnosing simulated cardiac murmurs. We examined diagnostic accuracy and learning trace data across sessions, and conducted semi-structured interviews to explore participants' understandings of their underlying choices and learning strategies. SRL participants' outcomes were non-inferior to Co-RL participants on the immediate post-test and retention test, but not on the PFL assessment (i.e., inconclusive). Analyzing interview transcripts (N = 31) generated three themes: perceived utility of initial learning supports for future learning; SRL strategies and sequencing of murmurs; and perceived control over learning across sessions. Co-RL participants regularly described relinquishing control of learning to supervisors and regaining it when on their own. For some trainees, Co-RL seemed to interfere with their situated and future SRL. We posit that transient clinical training sessions, typical in simulation-based and workplace-based settings, may not allow the ideal processes of Co-RL to unfold between supervisor and trainee. Future research must examine how supervisors and trainees can share accountability to develop the shared mental models that underlie effective Co-RL. [ABSTRACT FROM AUTHOR]

Background: Cardiac myxomas are benign tumours that can occur in any heart chamber or valve. They are extremely rare in dogs. We present a novel case involving a cardiac myxoma in the left ventricular outflow tract (LVOT) and a ventricular septal defect (VSD) in a small dog. Case Description: A female miniature dachshund (age, 7 months; weight, 2.88 kg) presented with growth insufficiency, lethargy, and a cardiac murmur. Echocardiography revealed a small polypoid mass in the LVOT and a membranous VSD. Simultaneous surgeries were performed to resect the mass (aortotomy) and close the VSD (right atriotomy) using low-flow cardiopulmonary bypass with surface-cooling hypothermia and retrograde cardioplegia. The tumour was histopathologically identified as a myxoma. The dog survived with no cardiac complications for 11 years after surgery. Conclusion: To our knowledge, this is the first report of ante-mortem diagnosis and simultaneous surgical repair of a cardiac myxoma obstructing the LVOT and a VSD in a small-breed dog. In addition to describing this complicated case, this report presents what we believe is the first reported use of retrograde cardioplegia during open-heart surgery in a small-breed dog. [ABSTRACT FROM AUTHOR]

Simple Summary: Cardiac murmurs caused by aortic or mitral insufficiency in horses often prompt further diagnostics to determine if the valvular insufficiencies affect the performance, safety, and life expectancy of the horse. Ambulatory acoustic cardiography (Audicor®) provides qualitative and quantitative information on hemodynamics and cardiac mechanical function and may aid in clinical diagnosis and prognostication of heart disease. The objective of this study was to investigate the use of acoustic cardiography in horses with aortic or mitral valve insufficiency. The results do not suggest any added clinical value of using the Audicor® device to detect heart murmurs and quantify alterations in cardiac hemodynamics and mechanical function in horses with aortic and mitral insufficiency that are not experiencing heart failure. Mitral and aortic valve insufficiencies have been commonly reported in horses. The objective of this study was to establish the use of acoustic cardiography (Audicor®) in horses with aortic (AI) or mitral valve insufficiency (MI). A total of 17 healthy horses, 18 horses with AI, and 28 horses with MI were prospectively included. None of the horses was in heart failure. Echocardiography and Audicor® analyses were conducted. Electromechanical activating time (EMAT), rate-corrected EMATc, left ventricular systolic time (LVST), rate-corrected LVSTc, and intensity and persistence of the third and fourth heart sound (S3, S4) were reported by Audicor®. Graphical analysis of the three-dimensional (3D) phonocardiogram served to visually detect murmurs. Audicor® snapshot variables were compared between groups using one-way ANOVA followed by Tukey's multiple-comparisons test. The association between Audicor® snapshot variables and the corresponding echocardiographic variables was investigated by linear regression and Bland–Altman analyses. Heart murmurs were not displayed on Audicor® phonocardiograms. No significant differences were found between Audicor® variables obtained in clinically healthy horses and horses with valvular insufficiency. The Audicor® device is unable to detect heart murmurs in horses. Audicor® variables representing cardiac function are not markedly altered, and their association with corresponding echocardiographic variables is poor in horses with valvular insufficiency that are not in heart failure. [ABSTRACT FROM AUTHOR]