A systolic murmur best heard at the aortic area with radiation to the neck is considered a hallmark of aortic stenosis. We report a patient with this auscultatory pattern in whom investigation revealed an unexpected diagnosis. Accompanying symptoms reinforced the initial suspicion, adding another layer of complexity to the diagnostic process. This case highlights the limitations of relying solely on symptom profile and murmur topography, and underscores the importance of comprehensive physical examination and diagnostic imaging in evaluating valvular heart disease.

Mixed-pathogen infective endocarditis is uncommon and may be difficult to recognize when the clinical course is prolonged and nonspecific. We report a case of mixed Candida albicans and Brucella melitensis native aortic valve endocarditis in a 37-year-old previously healthy man who presented with five months of intermittent fever, chills, anorexia, fatigue, 7 kg weight loss, progressive dyspnea, and intermittent chest pain. Physical examination revealed fever, sinus tachycardia, wide pulse pressure, elevated jugular venous pressure, bibasilar crackles, and a loud early diastolic murmur. Laboratory testing was notable for leukocytosis, anemia, mild thrombocytosis, and elevated inflammatory markers. A transthoracic echocardiogram demonstrated severe aortic regurgitation with a large 19 mm aortic valve vegetation causing holodiastolic flow reversal in the descending thoracic aorta. A transesophageal echocardiogram revealed two large mobile vegetations causing severe leaflet malcoaptation with possible periannular extension. A cardiac CT scan revealed thickening of the aortic root consistent with abscess formation. Blood cultures were positive for Candida albicans and Brucella melitensis. Brucella serology was positive, with an agglutination titer of 1:640. The patient developed pulmonary edema requiring an urgent Bentall procedure with a mechanical composite graft. Valve tissue cultures were positive for Candida albicans, and histopathology from the resected valve was consistent with acute-phase infective endocarditis with features of necrosis, fibrin, and debris. The patient was placed on postoperative antifungal treatment with caspofungin followed by fluconazole suppression, and on Brucella-directed treatment with doxycycline, rifampin, and levofloxacin for a planned six-month course of therapy. A postoperative whole-body PET/CT scan using fluorine-18 fluorodeoxyglucose (18F-FDG) did not demonstrate any residual cardiac infection or extracardiac infectious foci. The patient was doing well clinically at the three-month follow-up, with no signs or symptoms of heart failure and no evidence of relapse or recurrence of fever. This is a rare case of destructive native aortic valve endocarditis with mixed fungal and zoonotic bacterial etiologies that required urgent surgical source control and prolonged combined antimicrobial therapy.

Anurse-led heart murmur clinic was introduced at Sheffield Children's Hospital in 2023 to reduce waiting times, support the clinical nurse specialist (CNS) role development, and improve cost-efficiency. By triaging appropriate referrals to a CNS-led pathway with pre-arranged echocardiography and telephone follow-up, the clinic reduced wait times from 16 to 5-6 weeks and saved over £3,000 in its first year. The model demonstrates that nurse-led services can safely and effectively manage selected paediatric referrals, improve access to care, and deliver measurable service efficiencies.

Pediatric heart murmurs are common findings during physical examination, but only a small number of cases require intervention. This case report highlights a routine physical examination for a 10-year-old male patient that revealed a grade III/VI harsh systolic murmur heard in all areas of auscultation and a fixed split S2. A subsequent transthoracic echocardiogram showed an atrial septal defect that required catheter-based closure. This case proved to be one of the few cases in which urgent treatment of the heart murmur is required, and it helps highlight the features of pathologic murmurs that should prompt further evaluation.

Aging is associated with an increased risk of morbidity, multimorbidity and mortality in cats. However, longitudinal cohort studies are somewhat limited in this species. Information about the prevalence and incidence of age-related disease, combinations of morbidities, and factors associated with mortality could provide insights into the impact of aging on the welfare of domestic cats.

Phonocardiogram (PCG) is a graphical representation of heart sounds and murmurs, playing a vital role in the early screening and prevention of cardiovascular diseases (CVDs). In this study, we propose a first camera-stethoscope that is capable of recording PCG contactlessly, enabled by the principle of defocused speckle imaging (DSI). By illuminating the chest surface adjacent to the heart with a laser beam and employing a defocused camera to capture the reflected laser speckle interference, the subtle cardiac vibrations involved in heart sound generation are magnified and measured. By adjusting the defocused level, we can achieve different amplification effects of heart sounds. Additionally, we propose an algorithm to extract PCG signals from the video, including the fast detection of S1 and S2 events. In laboratory experiments, we evaluated the robustness of laser positioning and revealed a nonlinear amplification relationship between defocused level and PCG signals. The reliability of camera-stethoscope has been validated on 21 healthy adult subjects against the reference of contact electronic stethoscope. Moreover, we conducted clinical validation in the Department of Ultrasound. The proposed camera-stethoscope achieved F1-scores of 0.94 for both S1 and S2 detection on 45 patients, demonstrating its reliability and clinical potential. This work established the fundamental optical sensing model and algorithms for novel PCG monitoring.

Nonbacterial thrombotic endocarditis (NBTE) is a rare cardiac manifestation of antiphospholipid syndrome (APS) and may also occur in patients with malignancy. It can mimic infective endocarditis or rheumatic mitral valve disease and often results in valvular disease and embolic complications.

Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly characterized by four aortic cusps instead of the normal three. It is most commonly associated with progressive aortic regurgitation and is often diagnosed incidentally on echocardiography. A woman in her fifties presented with palpitations and exertional dyspnea (New York Heart Association Class II). Clinical examination revealed an early diastolic murmur at the left sternal border. Transthoracic echocardiography demonstrated a QAV with Hurwitz and Roberts Type F morphology and moderate aortic regurgitation with preserved left ventricular systolic function. Transoesophageal echocardiography confirmed central cusp malcoaptation. The patient was managed conservatively and remained stable at 6-month follow-up. QAV is an uncommon congenital anomaly that may present in adulthood with aortic regurgitation. Echocardiography is essential for diagnosis and classification. Early recognition has important implications for surveillance and procedural planning.