American Heart Journal
Volume 152, Issue 1 , Pages 85.e1-85.e7 , July 2006

Effect of teaching and type of stethoscope on cardiac auscultatory performance

  • Kasper Iversen, MD

      Affiliations

    • Clinic of Cardiology, Rigshospitalet, Copenhagen Ø, Denmark
    • Corresponding Author InformationReprint requests: Kasper Iversen, MD, Clinic of Cardiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark.
  • ,
  • Ane Søgaard Teisner, MD

      Affiliations

    • Clinic of Cardiology, Amager Hospital, Copenhagen S, Denmark
  • ,
  • Morten Dalsgaard, MD

      Affiliations

    • Clinic of Cardiology, Rigshospitalet, Copenhagen Ø, Denmark
  • ,
  • Rasmus Greibe, MD

      Affiliations

    • Clinic of Cardiology, Amager Hospital, Copenhagen S, Denmark
  • ,
  • Hans Bording Timm, MD

      Affiliations

    • Clinic of Cardiology, Amager Hospital, Copenhagen S, Denmark
  • ,
  • Lene Theil Skovgaard, MSci

      Affiliations

    • Department of Biostatistics, University of Copenhagen, Copenhagen K, Denmark
  • ,
  • Asbjørn Hróbjartsson, MD, MPhil, PhD

      Affiliations

    • The Nordic Cochrane Center, Rigshospitalet, Copenhagen Ø, Denmark
  • ,
  • Ø. Copenhagen
  • ,
  • S. Copenhagen
  • ,
  • K. Copenhagen

Received 5 December 2005 ,Accepted 13 April 2006.

References 

  1. Barzilai B, Davis VG, Stone PH, et al. Prognostic significance of mitral regurgitation in acute myocardial infarction. The MILIS Study Group. Am J Cardiol. 1990;65:1169–1175
  2. Dey DK, Sundh V, Steen B. Do systolic murmurs predict mortality in the elderly? A 15-year longitudinal population study of 70-year-olds. Arch Gerontol Geriatr. 2004;38:191–200
  3. Drazner MH, Rame JE, Stevenson LW, et al. Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure. N Engl J Med. 2001;345:574–581
  4. Iversen K, Greibe R, Timm HB, et al. A randomized trial comparing electronic and conventional stethoscopes. Am J Med. 2005;118:1289
  5. Edgington ES. Randomization tests. 1995.
  6. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174
  7. Chizner MA. The diagnosis of heart disease by clinical assessment alone. Dis Mon. 2002;48:7–98
  8. Brorson S, Bagger J, Sylvest A, et al. Improved interobserver variation after training of doctors in the Neer system. A randomised trial. J Bone Joint Surg Br. 2002;84:950–954
  9. Abella M, Formolo J, Penney DG. Comparison of the acoustic properties of six popular stethoscopes. J Acoust Soc Am. 1992;91:2224–2228
  10. Ertel PY, Lawrence M, Song W. How to test stethoscopes. Med Res Eng. 1969;8:7–17
  11. Kindig JR, Beeson TP, Campbell RW, et al. Acoustical performance of the stethoscope: a comparative analysis. Am Heart J. 1982;104:269–275
  12. Grenier MC, Gagnon K, Genest J, et al. Clinical comparison of acoustic and electronic stethoscopes and design of a new electronic stethoscope. Am J Cardiol. 1998;81:653–656
  13. Philip JH, Raemer DB. An electronic stethoscope is judged better than conventional stethoscopes for anesthesia monitoring. J Clin Monit. 1986;2:151–154
  14. Favrat B, Pecoud A, Jaussi A. Teaching cardiac auscultation to trainees in internal medicine and family practice: does it work?. BMC Med Educ. 2004;4:5
  15. Barrett MJ, Lacey CS, Sekara AE, et al. Mastering cardiac murmurs: the power of repetition. Chest. 2004;126:470–475
  16. Mahnke CB, Nowalk A, Hofkosh D, et al. Comparison of two educational interventions on pediatric resident auscultation skills. Pediatrics. 2004;113:1331–1335
  17. Mangione S, Nieman LZ. Cardiac auscultatory skills of internal medicine and family practice trainees. A comparison of diagnostic proficiency. JAMA. 1997;278:717–722
  18. St Clair EW, Oddone EZ, Waugh RA, et al. Assessing housestaff diagnostic skills using a cardiology patient simulator. Ann Intern Med. 1992;117:751–756
  19. Attenhofer Jost CH, Turina J, Mayer K, et al. Echocardiography in the evaluation of systolic murmurs of unknown cause. Am J Med. 2000;108:614–620
  20. Barron JT, Manrose DL, Liebson PR, et al. Comparison of auscultation with two-dimensional and Doppler echocardiography in patients with suspected mitral valve prolapse. Clin Cardiol. 1988;11:A30
  21. Bloch A, Crittin J, Jaussi A. Should functional cardiac murmurs be diagnosed by auscultation or by Doppler echocardiography?. Clin Cardiol. 2001;24:767–769
  22. Reichlin S, Dieterle T, Camli C, et al. Initial clinical evaluation of cardiac systolic murmurs in the ED by noncardiologists. Am J Emerg Med. 2004;22:71–75
  23. Roldan CA, Shively BK, Crawford MH. Value of the cardiovascular physical examination for detecting valvular heart disease in asymptomatic subjects. Am J Cardiol. 1996;77:1327–1331
  24. Shry EA, Smithers MA, Mascette AM. Auscultation versus echocardiography in a healthy population with precordial murmur. Am J Cardiol. 2001;87:1428–1430
  25. Gadsbøll N, Høilund-Carlsen PF, Nielsen GG, et al. Symptoms and signs of heart failure in patients with myocardial infarction: reproducibility and relationship to chest X-ray, radionuclide ventriculography and right heart catheterization. Eur Heart J. 1989;10:1017–1028
  26. Ishmail AA, Wing S, Ferguson J, et al. Interobserver agreement by auscultation in the presence of a third heart sound in patients with congestive heart failure. Chest. 1987;91:870–873
  27. Lok CE, Morgan CD, Ranganathan N. The accuracy and interobserver agreement in detecting the ‘gallop sounds’ by cardiac auscultation. Chest. 1998;114:1283–1288
  28. Raftery EB, Holland WW. Examination of the heart: an investigation into variation. Am J Epidemiol. 1967;85:438–444
  29. Cohen MV, Spindola-Franco H. Correlation between left ventriculography, auscultation, and M-mode and two-dimensional echocardiography in mitral valve prolapse. Herz. 1988;13:293–308
  30. Dobrow RJ, Calatayud JB, Abraham S, et al. A study of physician variation in heart-sound interpretation. Med Ann Dist Columbia. 1964;33:305–308
  31. Forssell G, Jonasson R, Orinius E. Identifying severe aortic valvular stenosis by bedside examination. Acta Med Scand. 1985;218:397–400
  32. Griffiths RA, Sheldon MG. The clinical significance of systolic murmurs in the elderly. Age Ageing. 1975;4:99–104
  33. Maisel AS, Gilpin EA, Klein L, et al. The murmur of papillary muscle dysfunction in acute myocardial infarction: clinical features and prognostic implications. Am Heart J. 1986;112:705–711
  34. Heidenreich PA, Schnittger I, Hancock SL, et al. A systolic murmur is a common presentation of aortic regurgitation detected by echocardiography. Clin Cardiol. 2004;27:502–506
  35. Lembo NJ, Dell'Italia LJ, Crawford MH, et al. Bedside diagnosis of systolic murmurs. N Engl J Med. 1988;318:1572–1578
  36. Shub C. Echocardiography or auscultation? How to evaluate systolic murmurs. Can Fam Physician. 2003;49:163–167
  37. Stewart IM. Systolic murmurs in 525 healthy young adults. Br Heart J. 1951;13:561–565
  38. Gjørup T, Bugge PM, Jensen AM. Interobserver variation in assessment of respiratory signs. Acta Med Scand. 1984;216:61–66

 The study was supported by unrestricted grants given by Pfizer Denmark, Medicon Denmark, and the Diamond Foundation. None of the grantors had any influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; as well as preparation, review, and approval of the manuscript.

PII: S0002-8703(06)00347-4

doi: 10.1016/j.ahj.2006.04.013

American Heart Journal
Volume 152, Issue 1 , Pages 85.e1-85.e7 , July 2006