(Circulation. 1996;93:1250-1253.)
© 1996 American Heart Association, Inc.
Articles |
Cardiac Auscultation
A Glorious Past—But Does It Have a Future?
From the Indiana Heart Institute and St Vincent Hospital, Indianapolis, Ind.
Key Words: auscultation • diagnosis
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Introduction |
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For most of this century, the stethoscope has served as a critical diagnostic tool in cardiovascular evaluation. With the advent of numerous new diagnostic modalities, however, especially ultrasonic imaging and Doppler techniques, cardiac auscultation is receiving less emphasis in teaching and practice.1 To compound this problem further, phonocardiography, ie, the graphic recording of heart sounds, which had served as a valuable means for teaching and documenting auscultation, has been largely discarded in this country. Although medical training directors and their students generally believe that cardiac auscultation is a skill that physicians should master,1 there appears to be a widespread belief that this skill is of secondary importance because the same information is readily obtainable through newer technological means. Possibly as a result of this attitude, there is no structured teaching of cardiac auscultation in three fourths of American internal medicine programs and two thirds of cardiology programs.1 This will inevitably lead to poor practice and teaching of this technique at all levels of training. Although not as well documented, the same process of attrition is probably affecting the other cognitive skills of history taking and bedside examination.2 3 4
Conventional wisdom dictates that auscultation not only provides
important clinical information in itself but also is a
cost-effective means to select additional tests.5 To
support these assumptions, however, we must evaluate contemporary
information concerning not only how auscultation can be used for
additional test selection but also how it might, in comparison with
other testing methods, provide a source of information of independent
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