Heart murmurs recorded by a sensor based electronic stethoscope and e-mailed for remote assessment

Dahl, Lauritz Bredrup; Hasvold, Per; Arild, Eli; Hasvold, Toralf

doi:10.1136/adc.87.4.297

Cited by 61 publications

(47 citation statements)

References 33 publications

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“…Therefore, tele-auscultation may be best suited financially for government-based healthcare systems with the specific purpose of augmenting outreach clinics. 97,113 Finally, despite the increased costs, many providers and patients simply prefer or expect echocardiography for murmur evaluation. 103,119 Digitally recorded heart sounds also provide the opportunity for computerized analysis of this physiological data, referred to as computer-aided auscultation, and could be incorporated into an asynchronous tele-auscultation program.…”

Section: Tele-auscultationmentioning

confidence: 99%

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Satou¹,

Rheuban²,

Alverson³

et al. 2017

Circulation

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A dvancements in technology and broadband have revolutionized the current practice of medicine. The field of pediatric cardiology is no exception given the need for prompt diagnosis and reliance on cardiac imaging to identify infants and children with potentially life-threatening cardiovascular disease. As the relationship between telemedicine and pediatric cardiology has advanced, it has created a need to develop a broad, comprehensive document reviewing all the various aspects of telemedicine in pediatric cardiology. For more than a decade, a significant body of literature has been published describing individual experiences and practices, yet there remains no comprehensive statement or document summarizing this rapidly advancing field. In an effort to describe the collective experience and to provide structure and guidance for pediatric cardiology practitioners and healthcare providers, we have developed a scientific statement on the use of telemedicine in pediatric cardiology.Specific areas explored in this document include both neonatal and fetal teleechocardiography, implications for training community sonographers, pulse oximetry programs, qualitative improvement and appropriate use criteria initiatives, and remote electrophysiological monitoring. This document also includes teleconsultation and teleausculation, direct-to-consumer and home monitoring programs, and a look into the use of telemedicine and pediatric cardiology in the intensive care setting. Furthermore, a detailed review of the legislative, public policy, and legal aspects of telemedicine is provided, along with financial and reimbursement information.Several terms are used in the literature interchangeably; a brief explanation is provided to help readers of this document. The term telehealth is defined as the use of technology to bridge distances in any aspect of medicine; telemedicine is the specific application of technology to conduct clinical medicine at a distance. The term telecardiology is defined as the broad application of telemedicine in the field of cardiology specifically, and tele-echocardiography is the most common application used within this field. ECHOCARDIOGRAPHY AND TELEMEDICINEEchocardiography is the most commonly used noninvasive cardiovascular imaging modality and is considered to be both safe and cost-effective. Tele-echocardiography can be described as a process in which a provider or a technician obtains cardiovascular ultrasound images from a given patient and these images are subsequently transmitted to an offsite location where a cardiologist can provide further analysis and interpretation. Thus, tele-echocardiography enables expert interpretation and consultation in a rapid and potentially geographically disparate fashion, enabling prompt and accurate decision making involving triage, transport, and therapeutic priorities. Tele-echocardiography is now routinely used across the age and subspecialty spectrum in pediatric cardiology.

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Section: Tele-auscultationmentioning

confidence: 99%

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Satou¹,

Rheuban²,

Alverson³

et al. 2017

Circulation

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“…A recent development has been the transmission of heart sounds by e-mail to a cardiology centre where it is interpreted (13,14). Such a system should be of help to the physician faced with problem auscultatory findings, and could prevent unnecessary consultations, electrocardiograms, echocardiograms and patient travel.…”

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confidence: 99%

The paediatrician and cardiac auscultation

Douglas¹

2003

Paediatrics &Amp; Child Health

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The cardiac auscultation (CA) skills of paediatric residents and office-based paediatricians have recently been shown to be suboptimal. CA is known to have a high degree of specificity and sensitivity, and is inexpensive. New teaching aids and availability of surrogate patient heart sounds and murmurs now allow most physicians to acquire CA skills. These teaching aids should be available in all medical schools and in all postgraduate paediatric training programs. While the relationship between musicality and CA skill has not been proven, the author assumes this relationship to be valid. Specific learning objectives in CA should be established. Recognizing that the current trend is away from clinical examinations, students frequently are unaware that a CA learning deficit exists. Therefore, students' CA skills should be evaluated before medical school graduation and at the Royal College of Physicians and Surgeons specialty examination. Students with amusia (inability to distinguish pitch of sound) should be identified and consideration should be given to directing them away from a clinical specialty in which CA is important. Further study is required in the physiology of learning of CA. Appropriate action by medical school and paediatric postgraduate program directors and the Royal College will effect a higher standard of patient care by increasing CA skills, resulting in a more financially efficient system -something everyone is trying to achieve in these times of increasing medical care costs.Key Words: Cardiac auscultation; Heart murmurs Le pédiatre et l'auscultation cardiaque Il a récemment été démontré que les compétences en matière d'auscultation cardiaque (AC) des résidents en pédiatrie et des pédiatres en cabinet sont sous-optimales. Il est établi que l'AC a un degré élevé de spécificité et de sensibilité et qu'elle est peu coûteuse. Du matériel didactique et l'accessibilité à des sons et à des murmures cardiaques de patients permettent maintenant à la plupart des médecins d'acquérir des compétences en AC. Ce matériel didactique devrait être disponible dans toutes les facultés de médecine et dans tous les programmes de formation surspécialisés en pédiatrie. Bien que le lien entre la musicalité et les compétences en AC n'ait pas été démontré, l'auteur en présume la validité. Des objectifs d'apprentissage précis de l'AC devraient être établis. Puisque la tendance actuelle s'éloigne des examens cliniques, il arrive souvent que les étudiants n'aient pas conscience de leur défaillance d'apprentissage en AC. Par conséquent, les compétences en AC des étudiants devraient être évaluées avant la collation des grades et à l'examen de spécialité du Collège royal. Les étudiants atteints d'asonie (incapacité de distinguer le ton des sons) devraient être repérés, et il faudrait envisager de les orienter loin d'une spécialité clinique dans laquelle l'AC est importante. Des études plus approfondies s'imposent sur la physiologie de l'apprentissage de l'AC. Des mesures pertinentes par les facultés de médecine, les directeur...

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“…These systems can distinguish between physiologic and pathologic murmurs with excellent sensitivity and specificity, [26][27][28][29] but have been tested only by pediatric cardiologists and not by primary care physicians. The clinical standing test that we report here had lower sensitivity for the diagnosis of physiologic murmurs, as 40% of children with these murmurs were not correctly classified.…”

Section: Discussionmentioning

confidence: 99%

Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children

Lefort¹,

Cheyssac²,

Soulé³

et al. 2017

Ann Fam Med

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PURPOSEThe distinction between physiologic (innocent) and pathologic (organic) heart murmurs is not always easy in routine practice, leading too often to unnecessary cardiology referrals and expensive investigations. We aimed to test the hypothesis that the complete disappearance of murmur on standing can exclude cardiac disease in children.METHODS From January 2014 to January 2015, we prospectively included 194 consecutive children aged 2 to 18 years who were referred for heart murmur evaluation to pediatric cardiologists at 2 French medical centers. Heart murmur characteristics while supine and then while standing were recorded, and an echocardiogram was performed.RESULTS Overall, 30 (15%) of the 194 children had a pathologic heart murmur as determined by an abnormal echocardiogram. Among the 100 children (51%) who had a murmur that was present while they were supine but completely disappeared when they stood up, only 2 had a pathologic murmur, and just 1 of them needed further evaluation. Complete disappearance of the heart murmur on standing therefore excluded a pathologic murmur with a high positive predictive value of 98% and specificity of 93%, albeit with a lower sensitivity of 60%.CONCLUSIONS Disappearance of a heart murmur on standing is a reliable clinical tool for ruling out pathologic heart murmurs in children aged 2 years and older. This basic clinical assessment would avoid many unnecessary referrals to cardiologists. 2017;15:523-528. https://doi.org/10.1370/afm.2105. Ann Fam Med INTRODUCTIONH eart murmur is a clinical finding currently affecting about 65% to 80% of schoolchildren 1,2 and one of the most common reasons for referral to cardiologists. Most murmurs are physiologic (innocent) 3 and result from the normal pattern of blood flow through the cardiac cavities and vessels. In a few cases, however, the murmur may be the single symptom of cardiac disease, even if most congenital heart diseases are diagnosed before birth or during the first year of life. 1Differences between physiologic and pathologic murmurs are well known, 4-9 but primary care physicians in family medicine or pediatricians too frequently refer their patients to pediatric cardiologists because they fear missing a heart disease diagnosis, resulting in unneeded parental anxiety, time consumption, and expensive evaluations. 10,11 Several clinical features of the murmur such as intensity, timing, quality and pitch, and the presence of a click are subjective and require extensive training for use to distinguish between physiologic and pathologic murmur. A simple, objective, and robust clinical test to exclude cardiac disease in apparently healthy children could prevent many unnecessary referrals.McLaren et al 12 reported that the prevalence of physiologic heart murmur in schoolchildren was 65% when they were in a supine position, whereas it was only 15% when they were standing. To our knowledge, however, no study has demonstrated that the disappearance of murmur 524on standing can allow clinicians to rule out a murmur ...

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Heart murmurs recorded by a sensor based electronic stethoscope and e-mailed for remote assessment

Cited by 61 publications

References 33 publications

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

The paediatrician and cardiac auscultation

Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children

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