Should Auscultation Be Rehabilitated?

Craige, Ernest

doi:10.1056/nejm198806163182409

Cited by 57 publications

(31 citation statements)

References 7 publications

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“…The patients were selected from those attending his private practice. The main echocardiographically confirmed diagnoses to be identified were aortic regurgitation [3], aortic stenosis [1], mitral regurgitation [4], mitral stenosis [2], LV dysfunction [3], pulmonary hypertension with tricuspid regurgitation [1], surgically corrected tetralogy of Fallot [1], ductus arteriosus [1], and ventricular septal defect [1]. Thus, the key signs to identify were abnormalities of normal heart sounds S1/S2, systolic and diastolic murmurs as well as ejection click, opening snap and additional diastolic sounds S3/S4.…”

Section: Methodsmentioning

confidence: 99%

Teaching cardiac auscultation to trainees in internal medicine and family practice: Does it work?

2004

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Background: The general proficiency in physical diagnostic skills seems to be declining in relation to the development of new technologies. The few studies that have examined this question have invariably used recordings of cardiac events obtained from patients. However, this type of evaluation may not correlate particularly well with bedside skills. Our objectives were 1) To compare the cardiac auscultatory skills of physicians in training with those of experienced cardiologists by using real patients to test bedside diagnostic skills. 2) To evaluate the impact of a five-month bedside cardiac auscultation training program.

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Section: Methodsmentioning

confidence: 99%

Teaching cardiac auscultation to trainees in internal medicine and family practice: Does it work?

2004

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“…Since the advent of technological aids to diagnosis (TAD) such as echocardiography in the late 1970s, 4 the central role of physical examination in the practice of clinical cardiology has been challenged, [5][6][7] and its standard of practice has declined in some countries. [8][9][10][11][12] Despite this, many clinicians still use and attach significance to physical examination techniques in daily practice.…”

Section: Introductionmentioning

confidence: 99%

How valuable is physical examination of the cardiovascular system?

Elder¹,

Japp²,

Verghese

2016

BMJ

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Physical examination of the cardiovascular system is central to contemporary teaching and practice in clinical medicine. Evidence about its value focuses on its diagnostic accuracy and varies widely in methodological quality and statistical power. This makes collation, analysis, and understanding of results difficult and limits their application to daily clinical practice. Specific factors affecting interpretation and clinical application include poor standardisation of observers' technique and training, the study of single signs rather than multiple signs or signs in combination with symptoms, and the tendency to compare physical examination directly with technological aids to diagnosis rather than explore diagnostic strategies that combine both. Other potential aspects of the value of physical examination, such as cost effectiveness or patients' perceptions, are poorly studied. This review summarises the evidence for the clinical value of physical examination of the cardiovascular system. The best was judged to relate to the detection and evaluation of valvular heart disease, the diagnosis and treatment of heart failure, the jugular venous pulse in the assessment of central venous pressure, and the detection of atrial fibrillation, peripheral arterial disease, impaired perfusion, and aortic and carotid disease. Although technological aids to diagnosis are likely to become even more widely available at the point of care, the evidence suggests that further research into the value of physical examination of the cardiovascular system is needed, particularly in low resource settings and as a potential means of limiting inappropriate overuse of technological aids to diagnosis.

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“…In the previously mentioned studies that suggest a low incidence of S3 detection in heart failure, it is possible that the physicians may have been unable to detect a sound that was truly present. Recent studies indicate that physicians are becoming less proficient at performing the physical examination, and physicians in residency programs have been shown to have poor cardiac auscultatory skills [33][34][35][36][37]. Furthermore, inter-observer agreement of S3 detection is poor, with board-certified cardiologists having no better agreement than house staff [38][39][40].…”

Section: Significance Of S3 and S4 Detection In Heart Failurementioning

confidence: 99%

The third heart sound for diagnosis of acute heart failure

Johnston

Collins²,

Storrow³

2007

Curr Heart Fail Rep

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Dyspnea is a common presenting complaint in the emergency department (ED). Rapid identification of heart failure as the etiology leads to early implementation of targeted therapies. Although having only intermediate sensitivity, the S3 is a highly specific finding among older adults with heart failure. Identification of an S3 by routine auscultation can be problematic given the chaotic and noisy ED environment, patient comorbid conditions, and intolerance of ideal positioning for auscultation. Technologies using computerized analysis of digitally recorded heart tones have recently been developed to aid the clinician with bedside detection of abnormal heart sounds. Data using these technologies and their applications in the ED are reviewed as well as implications for future use and research.

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Should Auscultation Be Rehabilitated?

Cited by 57 publications

References 7 publications

Teaching cardiac auscultation to trainees in internal medicine and family practice: Does it work?

Teaching cardiac auscultation to trainees in internal medicine and family practice: Does it work?

How valuable is physical examination of the cardiovascular system?

The third heart sound for diagnosis of acute heart failure

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