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PubMed1982

Diagnosis of aortic insufficiency: comparison of auscultation and M-mode echocardiography to angiography.

We compared auscultation and M-mode echocardiography to supravalvular aortography in 75 patients with chronic aortic insufficiency. Angiographic evidence of aortic insufficiency was present in 66 patients and absent in nine. Auscultation had a sensitivity of 72.7% (48/66) and a specificity of 77.8% (7/9). Echocardiography had a sensitivity of 75.8% (50/66) and specificity of 77.8% (7/9). When both methods were used in combination, their sensitivity for diagnosis of aortic insufficiency increased to 92.9% (61/66). The specificity did not change. Our data suggest that when used alone neither auscultation nor echocardiography is a sensitive method for detecting aortic insufficiency, but when used in combination they are excellent indicators for the presence or absence of aortic insufficiency.

Aortic Valve↗
PubMed1981

Arterial auscultation in peripheral vascular disease.

Bruits between epigastrium and popliteal fossae were found in 63% of 309 patients with arterial obstruction and in 7% of 149 patients without obstruction. In the former group, ankle systolic pressure at rest was abnormal in 85% of limbs with bruits, indicating a hemodynamic abnormality. In the majority of limbs with bruits and normal pressures at rest, an abnormal pressure response to exercise suggests that auscultation is useful in detection of even milder arterial lesions. Auscultation, after exercise and during compression of arterial branches distal to the bruits, may unmark stenotic lesions that do not produce audible bruits at rest and may localize bruit-producing lesions. This study indicates that peripheral auscultation is a valuable technique for assessing the arterial system in individual patients and for screening population groups.

Arterial Occlusive Diseases↗
PubMed1994

Enhanced auscultation with a new graphic display system.

BACKGROUND: To provide an objective method to support and teach auscultation, a new portable system (graphic display system) was evaluated for graphic display and printing of heart sounds. METHODS: Ninety-one patients from three institutions, with a variety of heart sound abnormalities, were studied by two examiners. A graphic recording was made in each and compared with the auscultatory findings. RESULTS: The findings of the graphic system confirmed the auscultatory impressions of both examiners in 77 (85%) of the 91 cases. Brief sound transients, such as split second sounds and ejection sounds, third heart sounds, and prosthetic opening and closing sounds, were all regularly recorded with the graphic system, often allowing resolution when examiners were in disagreement. Graphic recordings commonly were at variance with examiners in detecting fourth sounds, possibly because of examiners' difficulty in distinguishing these from split first sounds as well as limitations of the graphic system itself. High-pitched murmurs of low intensity (< grade 2), as exemplified by those of aortic and mitral regurgitation, were occasionally missed by the graphic system, probably because of baseline interference by background noise. CONCLUSIONS: The graphic display system can often provide more information than can be obtained by standard auscultation alone, especially in the detection of low-frequency and multiple sounds, and in the accurate timing of intervals. It is often unable to detect soft high-frequency murmurs. Permanent records allow for more objective comparison of the auscultatory findings of various examiners at different times. This system provides an excellent means by which auscultation skills may be taught or enhanced, especially since its speed and portability allow immediate feedback for comparison with auditory perceptions.

Computer Graphics↗
PubMedDate not supplied

Projection of the triangle of auscultation on the human pulmonary surface.

The projection of the triangle of auscultation on the posterior aspect of the pleuropulmonary surface was studied in 36 embalmed cadavers (19 males and 17 females). A total of 58 observations was made in 22 cadavers bilaterally and in 14 unilaterally, after introducing a long pin at each angle of the dissected triangle of auscultation deep into the pulmonary parenchyma. The projection of the triangle of auscultation, limited by the m. latissimus dorsi, m. trapezius and the medial margin of the scapula, was always found on the inferior lobe of the corresponding lung in one or more segments. It was found on the superior segment of the inferior lobe (43.1% isolatedly; 67.2% with other segments), the posterior basal segment (13.8% isolatedly; 43.1% with other segments) and on the lateral basal segment (10.3% isolatedly; 39.7% with other segments). Identical bilateral projections occurred in 50% of the cases.

Adult↗
PubMed2005

Auscultation and echocardiographic findings in Bull Terriers with and without polycystic kidney disease.

OBJECTIVE: To investigate a possible association between Bull Terrier polycystic kidney disease (BTPKD) and cardiac disease, to determine the prevalence of mitral valve disease (MVD) and left ventricular outflow tract obstruction (LVOTO) in the Australian Bull Terrier population, and to compare auscultation and echocardiography in detection of cardiac disease in Bull Terriers. DESIGN: Ninety-nine Bull Terriers, ranging in age from 8 weeks to 13 years and 11 months were auscultated and examined using renal ultrasonography; 86 were also examined using echocardiography. The prevalence and severity of heart defects in dogs with BTPKD was compared with that in dogs without BTPKD. RESULTS: Nineteen of these 99 dogs were diagnosed with BTPKD. Forty-two percent of Bull Terriers with BTPKD and 28% of those without BTPKD had murmurs characteristic of mitral regurgitation or LVOTO. How recently an animal was descended from an ancestor with BTPKD was associated with presence (P = 0.008) and loudness of a murmur (P = 0.009). Overall, echocardiography detected MVD in 39% of Bull Terriers, with increased prevalence in older animals (P = 0.003). Mitral stenosis was found in eight cases. Fifty-three percent of dogs in this study had evidence of LVOTO, with obstruction consisting of a complex of lesions including dynamic or fixed subvalvular LVOTO, significantly narrowed left ventricular outflow tract or valvular aortic stenosis. Dogs with BTPKD, or those descended from dogs with BTPKD, were more likely to have MVD (P = 0.006), and while LVOTO was not more common in these dogs, if they did have LVOTO, they were more likely to have severe obstruction than dogs with no ancestors with BTPKD (analysed in three ways P = 0.028 to 0.001). In this study, 46% of Bull Terriers without a murmur or arrhythmia had cardiac disease detected on echocardiographic examination. CONCLUSION: Cardiac disease, especially MVD and LVOTO, was common in Bull Terriers in this study, and those with BTPKD had an increased risk of cardiac abnormalities. Auscultation did not detect a significant number of Bull Terriers with cardiac disease.

Animals↗
PubMed1999

Routine heart and lung auscultation in prenatal care.

OBJECTIVE: To determine the value of routine heart and lung auscultation (HLA) in pregnant women. METHODS: Descriptive study by record review of maternal case-files. RESULTS: Of 3191 mothers, there were 24 with heart disease (0.8%) and 53 with lung disease (1.7%). On routine HLA, only two new cases of heart disease, both with asymptomatic valvular conditions, were detected, and none of lung disease. CONCLUSION: Routine chest auscultation is of very little value in prenatal care.

Auscultation↗
PubMedDate not supplied

[Method of evaluating the acoustic properties of devices for auscultation].

It is suggested that the appraisal of acoustic properties of auscultation instruments should be done by an expert-physician by following the most outstanding auscultative characteristics. A procedure for medical appraisal of acoustic properties is proposed. The BF-1 sthetophonendoscope manufactured by the Nizhny-Tagil medical instruments plant is recommended to serve as a model one.

Acoustics↗
PubMed1999

Cardiopulmonary auscultation: duo for strings--Opus 99.

In spite of increasing mechanization in medicine and reliance on "high-tech" diagnostic tools, bedside clinical skills of the attending physician can still identify findings that are missed by the more sophisticated devices. Using a stethoscope, we relied on our skills in inspection, palpation, percussion, auscultation, as well as echocardiography and phonocardiography to diagnose a patient whose murmur was very reminiscent of the D-sharp pizzicato in the Cello Sonata in F, Opus 99, by Johannes Brahms. Initial echocardiography was not helpful. We suspected an anomalous chorda and confirmed this with phonocardiography and a second echocardiography. Although advances in cardiac imaging are extremely helpful, the use of simple clinical skills, in addition to being fun, is not obsolete. Cardiopulmonary auscultation should receive more emphasis in the medical school curriculum and clinical training.

Autopsy↗
PubMed1990

A new cardiac auscultation simulator.

We have successfully developed a new cardiac auscultation simulator by applying recently developed digital and computer technology, which digitally records, stores, modifies, and plays back heart sounds and murmurs characteristic of various heart diseases. The simulator is capable of playing back different heart sounds or murmurs at each auscultatory site (aortic, pulmonic, tricuspid, and mitral) of a human chest-sized mannequin (made of urethane foam), through four built-in speakers. We were able to listen to accurate reproductions of heart sounds and murmurs at the same timing as in real patients by any type of stethoscope used in routine medical practice. This compact and portable educational apparatus, which simulates realistic auscultatory sounds, will impact greatly on the medical training of cardiac auscultation for physicians, medical students, nurses, and paramedicals.

Computer Simulation↗
PubMed1995

Using cervical auscultation in the clinical dysphagia examination in long-term care.

The ability of the clinical dysphagia examination to identify patients who aspirate and to determine specialized diet management has been suspect. In long-term care, however, the clinical examination can be the only assessment procedure available to clinicians. Cervical auscultation with stethoscope was incorporated into the clinical examination for dysphagia in an attempt to enhance the clinical examination's ability to detect aspiration and to determine specialized diet management in long-term care. Comparison of the clinical examination's results with results from videofluoroscopy revealed significant agreement in both areas. Results support the use of cervical auscultation as a highly sensitive and specific method of dysphagia assessment in long-term care.

Adult↗
PubMed1991

Auscultation cannot distinguish esophageal from tracheal passage of tube.

We quantitatively compared the acoustic characteristics of passage of an endotracheal tube into the trachea with those of passage into the esophagus by analyzing the loudness and frequency (90% spectral edge frequency) of the sounds when auscultated at the suprasternal notch. We found that there was a significant difference (P less than 0.01) in maximum loudness between esophageal and tracheal intubations (0.15 +/- 0.05 and 0.25 +/- 0.06 V, respectively). However, there were no significant differences between the 90% spectral edge frequencies. We conclude that, without directly comparing the maximal acoustic amplitude of tracheal intubation with that of esophageal in each patient, one cannot distinguish between the two types of intubation by means of auscultation.

Auscultation↗
PubMed1980

Microvascular auscultation. A new technique, using a diplo-microphone, for analysis of blood flow at suture lines in small arteries.

A new atraumatic method for patency and blood flow control of microvascular anastomoses has been developed. Sounds proximal and distal to a suture line are separately detected by means of two specially modified miniature microphones built together as an auscultation unit and named a diplo-microphone. Transmission of the two amplified signals to a loudspeaker as well as to an oscilloscope screen allows analysis of patency at the anastomosis. Photos taken of the sound waves are individual records characterizing blood flow on both sides of the suture line. The new method has been tested in carotid arteries of Wistar rats. Sounds at stenoses and end-to-end anastomoses have been detected, and several characteristics of postoperative sound waves have been worked out. The new method has turned out to be more sensitive in detecting medium-sized stenoses than radical pressure tests performed with forceps. Construction and application of a diplo-microphone are described. Auscultation results of normal and stenosed arteries are discussed.

Amplifiers, Electronic↗
PubMed1992

Reliability of auscultation in positioning of double-lumen endobronchial tubes.

Auscultation is a well-established technique to confirm the position of double-lumen endobronchial tubes (DLTs). However, some authors have recommended that fibreoptic bronchoscopy (FOB) is also indicated. The aims of this study were to determine first if bronchoscopy after blind placement of DLTs improved positioning; and second if preoperative bronchoscopy could detect difficult intubation. Twenty-four patients undergoing aortic or lung surgery were studied. After intubation with a single-lumen tube, an initial FOB was performed by an independent observer to check the airway anatomy. Then, the single-lumen tube was replaced by a DLT using a classical "blind" intubation method. Subsequent FOB was performed first by the independent observer to record the DLT position and next by the investigators for improvement or correction of their positioning under visual control. Fibreoptic bronchoscopy after blind placement of DLTs resulted in repositioning 78% left-sided DLTs and 83% right-sided DLTs. Preoperative bronchoscopy did not always detect an airway abnormality which might lead to difficult positioning of the DLTs. In conclusion, auscultation is an unreliable method of confirming the position of DLTs and should be followed by fibreoptic bronchoscopy.

Adult↗
PubMed1984

Dynamic vascular auscultation.

Dynamic auscultation, defined as physiologic or pharmacologic maneuvers that alter cardiovascular sounds in predictable ways, is increasingly practiced in cardiac physical diagnosis. Dynamic maneuvers applicable to peripheral arterial sounds have also been described and deserve wider application since arterial occlusive disease is encountered frequently. These little-known maneuvers alter blood flow into and away from a critical stenosis, as well as flow through side branch arteries, thus allowing the examiner to accentuate and localize arterial bruits by modifying their intensity and duration. In this review, the pathophysiology of bruit production is applied to a description of specific bruit manipulations useful in the neck, chest, abdomen, and extremities. Application of these dynamic maneuvers during vascular auscultation should allow more discriminating use of subsequent expensive or invasive diagnostic procedures.

Abdomen↗
PubMedDate not supplied

Auscultated fetal heart rate accelerations. An alternative to the nonstress test.

This nonexperimental, descriptive correlational study was conducted to determine whether a significant difference exists between the results of an electronically monitored nonstress test (NST) and those of auscultation for single fetal heart rate acceleration, the auscultated acceleration test (AAT). Of 130 NSTs, both the NST and the AAT were reactive in 105 cases and both were nonreactive in seven cases. Eighteen nonreactive AATs went on to have reactive NSTs (72.00% false-positive rate). There were no reactive AATs that went on to have nonreactive NSTs (0% false-negative rate). Various recommendations are made for future research in an attempt to decrease the false-positive rate. The McNemar's test for data analysis used in previous research indicated that there was a significant difference between the two tests. However, the sensitivity (100%) and specificity (85.37%) of the AAT indicate that the test is valid in predicting the results of the NST and thus appears to be a valid screening tool for fetal well-being and may be a reliable alternative to the NST.

Adolescent↗
PubMed2004

Comparison of neural network predictors in the classification of tracheal-bronchial breath sounds by respiratory auscultation.

Despite extensive research in the area of identification and discrimination of tracheal-bronchial breath sounds by computer analysis, the process of identifying auscultated sounds is still subject to high estimation uncertainties. Here we assess the performance of the relatively new constructive probabilistic neural network (CPNN) against the more common classifiers, namely the multilayer perceptron (MLP) and radial basis function network (RBFN), in classifying a broad range of tracheal-bronchial breath sounds. We present our data as signal estimation models of the tracheal-bronchial frequency spectra. We have examined the trained structure of the CPNN with respect to the other architectures and conclude that this architecture offers an attractive means with which to analyse this type of data. This is based partly on the classification accuracies attained by the CPNN, MLP and RBFN which were 97.8, 77.8 and 96.2%, respectively. We concluded that CPNN and RBFN networks are capable of working successfully with this data, with these architectures being acceptable in terms of topological size and computational overhead requirements. We further believe that the CPNN is an attractive classification mechanism for auscultated data analysis due to its optimal data model generation properties and computationally lightweight architecture.

Auscultation↗
PubMed2004

The physiology of cardiac auscultation.

Cardiac auscultation remains a critical component of the pediatric examination and is the primary method of diagnosis for the common innocent murmurs of childhood. This article outlines the significance of auscultation and defines the skills important for the diagnosis and recognition of common cardiac murmurs in childhood. The origin of heart sounds and murmurs is reviewed, and an approach to pediatric murmur evaluation is presented. The seven innocent murmurs of childhood and adolescence are reviewed in detail. Further diagnostic evaluation and referral depends the clinician's confidence and experience in recognizing and correctly characterizing these murmurs.

Adolescent↗
PubMed2000

Objective auscultation for traditional chinese medical diagnosis using novel acoustic parameters.

The goal of this work is to propose novel acoustic parameters of voice for the purpose of providing a quantitative analysis of auscultation in traditional Chinese medical diagnosis. There is rare amount of available literature related to this topic. Four novel acoustic parameters, the average number of zero-crossings, the variations in local peaks and valleys, the variations in first and second formant frequencies, and the spectral energy ratio, are presented to analyze and identify the characteristics among non-vacuity, qi-vacuity, and yin-vacuity subjects. Among these acoustic parameters, two temporal parameters, the average number of zero-crossings and the variations in local peaks and valleys, outperformed other parameters in classifying both non-vacuity and deficient subjects. The spectral energy ratio was adequate for the classification between qi-vacuity and yin-vacuity patients. This research is a first step in an ongoing effort to modernize the auscultation in traditional Chinese medical diagnosis.

Acoustics↗