1/35. Chordal rupture: a common complication of myxomatous degeneration of the mitral valve.In two patients with a clinical picture of acute mitral insufficiency, the presence of chordal rupture secondary to myxomatous degeneration of the mitral valve was disclosed during surgery. There was no evidence of previous rheumatic valvulitis, subacute bacterial endocarditis or other etiologies. It appears from the literature and from the cases described that ruptured chorda tendinea is a not uncommon complication of myxomatous transformation of the mitral valve. While this fact has been mentioned in anatomophological reports, clinicians are less aware of the association. In the absence of supportive evidence for a rheumatic or arteriosclerotic etiology, a clinical picture of acute mitral insufficiency should suggest ruptured chorda tendinea secondary to myxomatous degeneration of the mitral apparatus. This is particularly true in older patients, especially among those followed for a midsystolic click-late systolic murmur or an apical pansystolic murmur of pure mitral regurgitation.- - - - - - - - - - ranking = 1keywords = systolic murmur, murmur (Clic here for more details about this article) |
2/35. Cardiopulmonary auscultation: duo for strings--Opus 99.In spite of increasing mechanization in medicine and reliance on "high-tech" diagnostic tools, bedside clinical skills of the attending physician can still identify findings that are missed by the more sophisticated devices. Using a stethoscope, we relied on our skills in inspection, palpation, percussion, auscultation, as well as echocardiography and phonocardiography to diagnose a patient whose murmur was very reminiscent of the D-sharp pizzicato in the Cello Sonata in F, Opus 99, by Johannes Brahms. Initial echocardiography was not helpful. We suspected an anomalous chorda and confirmed this with phonocardiography and a second echocardiography. Although advances in cardiac imaging are extremely helpful, the use of simple clinical skills, in addition to being fun, is not obsolete. Cardiopulmonary auscultation should receive more emphasis in the medical school curriculum and clinical training.- - - - - - - - - - ranking = 0.013978657206576keywords = murmur (Clic here for more details about this article) |
3/35. neisseria meningitidis native valve endocarditis. A case report.The so-called nonpathogenic neisseriae are common inhabitants of the upper respiratory tract in humans and are not usually regarded as pathogens. Neisseria meningitidis on the contrary may cause severe disease. These organisms are an uncommon cause of infective endocarditis. The authors report a case of a 64 year-old male, type II diabetic, previously asymptomatic, admitted to hospital because of fever, aphasia and right hemi-paresis. A systolic murmur was heard at the cardiac apex, and three blood cultures were positive for neisseria meningitidis. The echocardiogram showed a vegetation on the posterior leaflet of the mitral valve, allowing the diagnosis of meningococcal endocarditis. The patient's clinical condition improved on intravenous penicillin therapy, and regression of fever, disappearance of the neurological signs and of the mitral valve vegetation were observed.- - - - - - - - - - ranking = 0.5keywords = systolic murmur, murmur (Clic here for more details about this article) |
4/35. Cases from the osler medical service at Johns Hopkins University.PRESENTING FEATURES: A 29-year-old woman with a history of rheumatic heart disease and one episode of endocarditis as an adolescent was admitted to the hospital after 1 week of headache, fever, and myalgia. Her past medical history was otherwise unremarkable and did not include illicit drug use. On physical examination, she had a previously noted 3/6 holosystolic murmur at the apex, which radiated to her back; a previously noted 1/4 diastolic murmur at the right upper sternal border; diminished strength in her right upper extremity; multiple painful erythematous nodules on her fingers (Figure 1); and red streaks under her nails (Figure 2). magnetic resonance imaging of the brain demonstrated multiple lesions; the largest was in the right frontal lobe with associated hemorrhage (Figure 3).What is the diagnosis?- - - - - - - - - - ranking = 0.51397865720658keywords = systolic murmur, murmur (Clic here for more details about this article) |
5/35. Native valve endocarditis due to pichia ohmeri.candida species can cause clinical manifestations in various organs of the cardiovascular system, i.e., the pericardium, myocardium, and endocardium, with endocarditis being the best-known clinical entity. endocarditis is seen primarily in intravenous drug users and in individuals with damaged native valves, especially in congenital heart disease or rheumatic valvular diseases, and in prosthetic heart valves. The authors present a case of pichia ohmeri endocarditis in an intravenous drug user, with an unusual presentation form. This is a case of a 42-year-old man, an intravenous heroin user, who was admitted to our Vascular Surgery Department because of fever and acute serious ischemia of the left inferior limb. He presented with fever (39 degrees C), a pale and cold left limb, absence of the left popliteal pulse, and a pansystolic murmur at the cardiac apex. The transthoracic echocardiogram showed a large vegetation on the anterior leaflet of the mitral valve and severe mitral regurgitation with good left ventricular systolic function. Empirical antibiotic therapy was started. Six days after admission, embolectomy was performed with partial clinical recovery. Three blood cultures and the embolus showed a teleomorphic form of candida guilliermondii - pichia ohmeri. Therapy with intravenous liposomal amphotericin b, fluocitosin, imipenem, and aztreonam was started. Two weeks later, his clinical condition deteriorated with acute heart failure refractory to medical therapy, mandating mechanical ventilation and high-dose vasopressor and inotropic amine support. He underwent urgent mitral valve replacement with a biologic prosthetic valve. Rapid stabilization of the cardiac status occurred, but ischemic limb lesions required further vascular interventions.- - - - - - - - - - ranking = 0.5keywords = systolic murmur, murmur (Clic here for more details about this article) |
6/35. Prolapsing mitral valve leaflet syndrome. A spectrum that includes cleft posterior mitral valve.Two patients with a prolapse and cleft posterior mitral leaflet were studied. The first case had an associated ostium secundum type atrial septal defect. In both cases, the pansystolic regurgitation of contrast material during angiography corresponded to the pansystolic configuration of the murmur. In each instance, the systolic murmurs displayed a late systolic accentuation during the maximal prolapse of the mitral valve. The echocardiographic studies demonstrated only a late systolic prolapse which in both patients corresponded angiocardiographically to the maximum buckling of the pansystolic prolapse. Echocardiographic and angiocardiographic features of cleft posterior mitral valve leaflet are discussed.- - - - - - - - - - ranking = 0.51397865720658keywords = systolic murmur, murmur (Clic here for more details about this article) |
7/35. pasteurella multocida aortic valve endocarditis: case report and literature review.pasteurella multocida is a rare cause of infective endocarditis that occurs mostly in immunocompromised patients and is therefore associated with a high mortality rate. The case is reported of a 48-year-old male patient with liver cirrhosis, who developed aortic valve endocarditis caused by P. multocida. The infection was detected by blood cultures. The patient presented with generalized symptoms and initial neurologic symptoms suggestive of meningitis. Transthoracic echocardiography conducted after the discovery of a diastolic murmur revealed a large vegetation on the aortic valve, and notable insufficiency. These findings were confirmed at surgery, where-upon the patient underwent aortic valve replacement using a bioprosthetic valve. Subsequently he developed a recurrent episode of endocarditis that was successfully treated with antibiotic therapy. Other similar cases reported in the literature are reviewed.- - - - - - - - - - ranking = 0.013978657206576keywords = murmur (Clic here for more details about this article) |
8/35. Additive value of transoesophageal echocardiography in the visualization of carcinoid heart disease.A 65-yr-old woman with atypical complaints and a tricuspid insufficiency murmur underwent transthoracic echocardiography, which showed right-sided abnormalities, but did not allow clear visualization of the valves. Subsequent transoesophageal imaging, however, raised the suspicion of carcinoid heart disease, because of the typical lesions. The diagnosis was thereafter confirmed by biochemical investigations, scintigraphy and abdominal ultrasound. This case suggests that transoesophageal echocardiography may have additive value in the detection of carcinoid heart disease.- - - - - - - - - - ranking = 0.013978657206576keywords = murmur (Clic here for more details about this article) |
9/35. arthrobacter woluwensis subacute infective endocarditis: case report and review of the literature.We report a case of endocarditis due to arthrobacter woluwensis and review the published reports of arthrobacter species isolated from human clinical samples. A 39-year-old injection drug user presented with fever and a new heart murmur. A. woluwensis was isolated from blood cultures, and a diagnosis of subacute infective endocarditis of the native mitral valve was made. The patient was successfully treated with a 6-week course of intravenous teicoplanin. From our review of the literature, we were able to retrieve data on 41 cases of arthrobacter species isolated from human clinical samples. However, arthrobacter species was documented as a cause of human disease on only 5 other occasions (2 cases of bacteremia, 1 case of postoperative endophthalmitis, 1 case of a whipple disease-like syndrome, and 1 case of phlebitis). Because of the difficulty of identifying arthrobacter strains by conventional biochemical assays, it is likely that infections with these coryneform bacteria are underreported.- - - - - - - - - - ranking = 0.013978657206576keywords = murmur (Clic here for more details about this article) |
10/35. Native quadruple-valve endocarditis caused by enterococcus faecalis.We report the case of a patient with postoperative, hospital-acquired, quadruple-valve endocarditis caused by enterococcus faecalis on presumed normal native valves. During a cervical laminectomy, the patient had a non-ST-elevation myocardial infarction that was treated conservatively. In the intensive care unit, the patient became febrile and developed a new 2/6 systolic murmur. blood cultures grew E. faecalis, and the patient was given antibiotics. Postoperative transthoracic echocardiography and transesophageal echocardiography revealed vegetations on all 4 heart valves. Subsequently, the patient was moved to another facility and died. No autopsy was performed. E. faecalis is the third-most-common cause of bacterial endocarditis overall; however, it is rarely found in multiple-valve, hospital-acquired endocarditis. Although transthoracic echocardiography is a powerful diagnostic tool, transesophageal echocardiography increases the sensitivity and specificity to about 90%. In our patient, the diagnosis of native quadruple-valve endocarditis would not have not been made without the use of transesophageal echocardiography.- - - - - - - - - - ranking = 0.5keywords = systolic murmur, murmur (Clic here for more details about this article) |
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