Title: Cardiac Auscultation Versus Two-dimensional Trans thoracic Echocardiography in Native Aortic and Mitral Valve diseases in Erbil City
Authors: Aree Nadhem A.Daham, Mohammed Hasan Al-Meshhadani
DOI: http://dx.doi.org/10.18535/jmscr/v4i7.51
Abstract
Background: Echocardiography is use for diagnosis and assessment of valvular heart disease as there are many valve diseases that are silent on clinical auscultation.
Objective: To identify the sensitivity of auscultation in patients with mitral and aortic valve diseases in comparison with Doppler echocardiography.
Materials and methods: An observational study was done on 950 patients were attended echocardiography department of Erbil cardiac center between May 2015 and February 2016, only 300 patients fulfils the criteria of the study were included in the study. Patients from the age of 15 years and above were randomly selected. Cardiac auscultation of mitral and aortic precordial areas was done by 2 experience cardiologists. Then patients were examined thoroughly by transthoracic echocardiography for underlying valve lesion.
Results: From total 189 MR lesions detected by echocardiography in 94 (49.7%) lesions no murmur was detected, from 36 MS lesions in 12 (33.3%) lesions no murmur was detected, from 86 AR lesions in 50 (58.1%) lesions and from total 40 AS lesions in 5 (12.5%) lesions the murmur were not detected clinically with a significant P value (p value=0.001), (p value=0.001), (p value=0.001), (p value=0.001) respectively. Significant association of inaudible murmurs with mild valve lesions on echocardiography (p value=0.001) and with echocardiographic systolic dysfunction (p value=0.001).Sensitivity of auscultation in mitral and aortic valve diseases was 55.7% and 48.4% respectively.
Conclusions: Many valve diseases which were diagnosed by echocardiography could be silent clinically
Keywords: Auscultation, Aortic valve, mitral valve, echocardiography.
References
1. Catherine M, Otto and Robert O, Bonow. Valvular heart disease. In: Douglas L. Mann, Douglas P. Zipes, Peter Libby, editors. Braunwald’s Heart Disease. Phila-delphia: Elsevier Saunders; 2015; p. 1690
2. Dare A, et al. Evaluation of surgically excised mitral valves: Revised recommendations, based on changing operative procedures in the 1990s.Hum Pathol 1993; 24:1286
3. Rosenhek R, Binder T, Porenta G. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000; 343:611-17.
4. Jeffrey R Bender, M.D. Heart Valve Disease.www. http://doc.med.yale.edu/heartbk/13
5. Tzemos N, Therrien J, Yip J, et al: Outcomes in adults with bicuspid aortic valves. JAMA 300:1317, 2008.
6. Nihoyannopoulos P, Fox K, Fraser A, Pinto F. EAE laboratory standards and accreditation. Eur J Echocardiogr. 2007; 8: 80–7.
7. Fink JC, Schmid CH, Selker HP. A decision aid for referring patients with systolic murmurs for echocardiography. J Gen Intern Med.1994; 9:479-84. of echocardiography in clinical trials. J Am Soc Echocardiogr. 2004;17:1086–1119.
8. Michael A. Chizner. Cardiac Auscultation: Rediscovering the Lost Art. Curr Probl Cardiol, 2008;33:326-40
9. Bickley, LS. Bates’ Guide to Physical Examination and History Taking. 7th edition, Philadelphia; Lippincott 1999.
10. Chatterjee K. Auscultation of cardiac murmurs. In: Up To Date, Rose, BD (Ed), Up To Date, Waltham, MA, 2006.
11. Michael A. Chizner, MD. Cardiac Auscultation: Rediscovering the Lost Art. Curr Probl Cardiol. 2008; 33:326-408.
12. Robert O Bonow, Blase Carabello, Antonio C. de Leon ,et al. Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease), 2014. Circulation, http www.circ.ahajournals.org
13. Catherine M, Otto and Robert O, Bonow.Valvular heart disease.In: Douglas L. Mann, Douglas P. Zipes, Peter Libby, editors. Braunwald’s Heart Disease. Philadelphia: Elsevier Saunders; 2015; p. 1708
14. Ashwin Reddy, Lt Col Sk Jatana, Col MNG Nair. Clinical Evaluation Versus Echocardiography in the Assessment of Rheumatic Heart Disease. MJAFI.2004; 60: 255-258
15. W M Jaffe, A. H Roche, H A Coverdale, H. F McAlister, J. A Ormiston and E. R Greene. Clinical Evaluation versus Doppler Echocardiography in the Quantitative Assessment of Valvular Heart Disease. Circulation. 1988; 78:267-275
16. Catherine M, Otto and Robert O, Bonow. Valvular heart disease. In: Douglas L. Mann, Douglas P. Zipes, Peter Libby,editors. Braunwald’s Heart Disease. Philadelphia: Elsevier Saunders; 2015; 1473-1484.