Appreciation of Precordial Cardiac Murmur on Examination Relative to Knowledge of Valvular Heart Disease

Codispoti, Cindy; Eckart, Robert E.; Rutberg, Samara A.; Shry, Eric A.; Boyd, Sheri Y. N.

doi:10.1097/01.crd.0000134916.93707.d0

Cited by 3 publications

(2 citation statements)

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“…In patients with confirmed mitral regurgitation at echocardiography, only one-third of doctors heard a murmur 15. Good clinical examination still has a role in patient care.…”

Section: Discussionmentioning

confidence: 99%

Auscultating heart and breath sounds through patients’ gowns: who does this and does it matter?

Rankin

2015

Postgraduate Medical Journal

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Background Doctors are taught to auscultate with the stethoscope applied to the skin, but in practice may be seen applying the stethoscope to the gown. Objectives To determine how often doctors auscultate heart and breath sounds through patients’ gowns, and to assess the impact of this approach on the quality of the sounds heard. Methods A sample of doctors in the west of Scotland were sent an email in 2014 inviting them to answer an anonymous questionnaire about how they auscultated heart and breath sounds. Normal heart sounds from two subjects were recorded through skin, through skin and gown, and through skin, gown and dressing gown. These were played to doctors, unaware of the origin of each recording, who completed a questionnaire about the method and quality of the sounds they heard. Results 206 of 445 (46%) doctors completed the questionnaire. 124 (60%) stated that they listened to patients’ heart sounds, and 156 (76%) to patients’ breath sounds, through patients’ gowns. Trainees were more likely to do this compared with consultants (OR 3.39, 95% CI 1.74 to 6.65). Doctors of all grades considered this practice affected the quality of the sounds heard. 32 doctors listened to the recorded heart sounds. 23 of the 64 (36%) skin and 23 of the 64 (36%) gown recordings were identified. The majority of doctors (74%) could not differentiate between skin or gown recordings, but could tell them apart from the double layer recordings (p=0.02). Trainees were more likely to hear artefactual added sounds (p=0.04). Conclusions Many doctors listen to patients’ heart and breath sounds through hospital gowns, at least occasionally. In a short test, most doctors could not distinguish between sounds heard through a gown or skin. Further work is needed to determine the impact of this approach to auscultation on the identification of murmurs and added sounds.

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“…In patients with confirmed mitral regurgitation at echocardiography, only one-third of doctors heard a murmur 15. Good clinical examination still has a role in patient care.…”

Section: Discussionmentioning

confidence: 99%

Auscultating heart and breath sounds through patients’ gowns: who does this and does it matter?

Rankin

2015

Postgraduate Medical Journal

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“…In two of the studies, the sensitivity was particularly low; and Codispoti et al (2005). Both were retrospective chart reviews.…”

Section: Factors Affecting Sensitivity and Specificitymentioning

confidence: 97%

Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review

et al. 2023

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ObjectiveThe objective of this study was to determine the diagnostic accuracy in detecting valvular heart disease (VHD) by heart auscultation, performed by medical doctors.Design/methodsA systematic literature search for diagnostic studies comparing heart auscultation to echocardiography or angiography, to evaluate VHD in adults, was performed in MEDLINE (1947–November 2021) and EMBASE (1947–November 2021). Two reviewers screened all references by title and abstract, to select studies to be included. Disagreements were resolved by consensus meetings. Reference lists of included studies were also screened. The results are presented as a narrative synthesis, and risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2.Main outcome measuresSensitivity, specificity and likelihood ratios (LRs).ResultsWe found 23 articles meeting the inclusion criteria. Auscultation was compared with full echocardiography in 15 of the articles; pulsed Doppler was used as reference standard in 2 articles, while aortography and ventriculography was used in 5 articles. One article used point-of-care ultrasound. The articles were published from year 1967 to 2021. Sensitivity of auscultation ranged from 30% to 100%, and specificity ranged from 28% to 100%. LRs ranged from 1.35 to 26. Most of the included studies used cardiologists or internal medicine residents or specialists as auscultators, whereas two used general practitioners and two studied several different auscultators.ConclusionSensitivity, specificity and LRs of auscultation varied considerably across the different studies. There is a sparsity of data from general practice, where auscultation of the heart is usually one of the main methods for detecting VHD. Based on this review, the diagnostic utility of auscultation is unclear and medical doctors should not rely too much on auscultation alone. More research is needed on how auscultation, together with other clinical findings and history, can be used to distinguish patients with VHD.PROSPERO registration numberCRD42018091675.

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Cardiac auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients

Gardezi¹,

Myerson²,

Chambers

et al. 2018

Heart

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Appreciation of Precordial Cardiac Murmur on Examination Relative to Knowledge of Valvular Heart Disease

Cited by 3 publications

References 11 publications

Auscultating heart and breath sounds through patients’ gowns: who does this and does it matter?

Auscultating heart and breath sounds through patients’ gowns: who does this and does it matter?

Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review

Cardiac auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients

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