{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T06:36:35Z","timestamp":1782974195549,"version":"3.54.5"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":2104,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T00:00:00Z","timestamp":1588032000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heart murmurs are detected commonly in apparently healthy cats during routine physical examination, and Doppler echocardiography ultimately is required to identify the source of flow turbulence causing the murmur. However, in some cases, the origin of the murmur cannot be identified on echocardiographic examination, even by experienced clinicians. The application of gentle pressure with the ultrasound transducer against the chest wall of a cat can induce temporary narrowing of the mid-right ventricular (RV) lumen, causing blood flow turbulence even in the absence of cardiac abnormalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives\/Hypotheses<\/jats:title>\n                    <jats:p>To evaluate the effect of pressure of the ultrasound transducer against the chest wall of cats during echocardiography (provocative testing) on RV blood flow. The main hypothesis is that provocative testing can increase RV outflow velocity and cause flow turbulence. The second hypothesis is that the effect of this maneuver is independent of changes in heart rate during testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Animals<\/jats:title>\n                    <jats:p>Sixty-one client-owned, apparently healthy cats with heart murmurs on physical examination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective review of echocardiographic examinations of 723 cats presented for investigation of a heart murmur.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Outflow systolic velocity increased from 1.05\u2009\u00b1\u20090.26 to 1.94\u2009\u00b1\u20090.51\u2009m\/s during provocative testing (P &amp;lt;\u2009.0001); no correlation was found between RV outflow peak velocity and heart rate during provocative testing (P =\u2009.34; r =\u20090.1237).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Clinical Relevance<\/jats:title>\n                    <jats:p>Right ventricular outflow tract obstruction and associated heart murmur can be iatrogenically induced in apparently healthy cats by increasing pressure on the right chest wall with an ultrasound probe.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jvim.15774","type":"journal-article","created":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T10:14:03Z","timestamp":1588068843000},"page":"1102-1107","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Heart murmurs in apparently healthy cats caused by iatrogenic dynamic right ventricular outflow tract obstruction"],"prefix":"10.1093","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6898-7900","authenticated-orcid":false,"given":"Luca","family":"Ferasin","sequence":"first","affiliation":[{"name":"Specialist Veterinary Cardiology Consultancy , Alton, Hampshire,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Ferasin","sequence":"additional","affiliation":[{"name":"Specialist Veterinary Cardiology Consultancy , Alton, Hampshire,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eoin","family":"Kilkenny","sequence":"additional","affiliation":[{"name":"Lumbry Park Veterinary Specialists \u2013 Cardiology , Alton, Hampshire,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,5,1]]},"reference":[{"key":"2026020922043998000_jvim15774-bib-0001","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jvc.2015.05.001","article-title":"Management of incidentally detected heart murmurs in dogs and cats","volume":"17","author":"Cote","year":"2015","journal-title":"J Vet Cardiol"},{"key":"2026020922043998000_jvim15774-bib-0002","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.2460\/javma.246.10.1076","article-title":"Management of incidentally detected heart murmurs in dogs and cats","volume":"246","author":"Cote","year":"2015","journal-title":"J Am Vet Med Assoc"},{"key":"2026020922043998000_jvim15774-bib-0003","doi-asserted-by":"crossref","first-page":"384","DOI":"10.2460\/javma.2004.225.384","article-title":"Assessment of the prevalence of heart murmurs in overtly healthy cats","volume":"225","author":"Cote","year":"2004","journal-title":"J Am Vet Med Assoc"},{"key":"2026020922043998000_jvim15774-bib-0004","first-page":"840","article-title":"Cause of heart murmurs in 57 apparently healthy cats","volume":"135","author":"Dirven","year":"2010","journal-title":"Tijdschr Diergeneeskd"},{"key":"2026020922043998000_jvim15774-bib-0005","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.2460\/javma.234.11.1398","article-title":"Prevalence of cardiomyopathy in apparently healthy cats","volume":"234","author":"Paige","year":"2009","journal-title":"J Am Vet Med Assoc"},{"issue":"3","key":"2026020922043998000_jvim15774-bib-0006","doi-asserted-by":"crossref","first-page":"S244","DOI":"10.1016\/j.jvc.2015.03.008","article-title":"Cardiomyopathy prevalence in 780 apparently healthy cats in rehoming centres (the CatScan study)","volume":"17","author":"Payne","year":"2015","journal-title":"J Vet Cardiol"},{"key":"2026020922043998000_jvim15774-bib-0007","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jvc.2010.05.003","article-title":"Comparison of auscultatory and echocardiographic findings in healthy adult cats","volume":"12","author":"Wagner","year":"2010","journal-title":"J Vet Cardiol"},{"key":"2026020922043998000_jvim15774-bib-0008","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1111\/j.1939-1676.1993.tb01015.x","article-title":"Recommendations for standards in transthoracic two-dimensional echocardiography in the dog and cat. 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