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PubMedDate not supplied

[Sphygmo-acoustic concordance. A valuable sign in cardiovascular examinations].

It is described an oscilloscopic-auscultatory sign named sphygmoaccoustic concordance (S-AC) which means that the changes of intensity of a cardiac or arterial murmur is concordant with the changes in the development of a pulse observed in a mechanical oscilloscope in an artery located near the site of murmur's origin. Sphygmo-accoustic discordance (S-AD) means incongruency of these phenomena. The cardiac murmurs was auscultated at the same time that the oscillation of the carotid artery was observed in a mechanical oscillometer, modify by the author, and the arterial murmur was examined during the performance of a traditional oscillomethry in a corporal segment near the site of murmur's production. 20 regurgitation murmurs (18 of mitral insufficiency, 9 of tricuspid insufficiency and 2 murmurs of interventricular septal defects) exhibit S-AD. 75% of ejective aortic murmurs had S-AC and the rest slight chronologic S-AD. 6 pulmonary ejective murmurs were discordant with the carotid pulse oscillation. 40 stenotic arterial murmurs had S-AC in relation to the proximal pulse. In 26 murmurs produced in a more than 50% lumen arterial stenosis a distal pulse was visualized an all had S-AD. The some finding was seen in 12 murmurs of arterial collateral circulation. In 34 functional arterial murmurs (flow murmurs without stenosis) there were S-AC in either, the proximal or distal pulse. The S-AC phenomenon is easy to perform and is a valuable bedside sign which is an aid in the recognition of some cardio-vascular murmurs.

Auscultation↗
PubMed1989

Predictive value of carotid bruit for carotid atherosclerosis.

To assess the predictive value of carotid bruit for moderate-to-severe carotid atherosclerosis, the results of carotid arteriograms performed on 1004 subjects were correlated with the findings of auscultation of the carotid arteries. Predictive values of carotid bruit for ipsilateral extracranial carotid atherosclerosis were 77% for localized bruits and 74% for diffuse bruits. The predictive values of extracranial carotid bruit for ipsilateral intracranial carotid atherosclerosis were 16% for localized bruits and 18% for diffuse bruits. Assessing both carotid arteries together, the predictive value of carotid bruit for moderate-to-severe atherosclerosis at any extracranial carotid site was 85%, there being no difference whether the bruits were diffuse, localized, bilateral, or unilateral. Diffuse or localized bruits, whether unilateral or bilateral, are equally predictive of moderate-to-severe atherosclerosis in the extracranial carotid artery, but both are poor predictors of intracranial carotid artery disease.

Adult↗
PubMed1975

Abdominal bruits. Clinical and angiographic correlation.

The results of abdominal auscultation were correlated with abdominal angiograms in 503 patients. Bruits were heard in 106 (21%). The majority of bruitswere in the epigastrium, mainly because of a high incidence of celiac artery stenosis usually of the extrinsic compression type. Sixty-seven patients had stenoses or occlusions of one or more renal arteries and 27 (40%) had bruits. Most of these patients, however, had other possible causes for their bruits, usually related to atherosclerosis of coincidental celiac compression. Collateral channels were considered to be the cause of epigastric bruits in eight of ten patients with complete occlusion of the celiac artery and in two patients with spelic artery occlusions. Collateral channels may be partly responsible for bruits in many patients with celiac artery stenosis.

Abdomen↗
PubMed2006

Does the clinical examination predict lower extremity peripheral arterial disease?

CONTEXT: Lower extremity peripheral arterial disease (PAD) is common and associated with significant increases in morbidity and mortality. Physicians typically depend on the clinical examination to identify patients who need further diagnostic testing. OBJECTIVE: To systematically review the accuracy and precision of the clinical examination for PAD. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: MEDLINE (January 1966 to March 2005) and Cochrane databases were searched for articles on the diagnosis of PAD based on physical examination published in the English language. Included studies compared an element of the history or physical examination with a reference standard of ankle-brachial index, duplex sonography, or angiogram. Seventeen of the 51 potential articles identified met inclusion criteria. Two of the authors independently extracted data, performed quality review, and used consensus to resolve any discrepancies. DATA SYNTHESIS: For asymptomatic patients, the most useful clinical findings to diagnose PAD are the presence of claudication (likelihood ratio [LR], 3.30; 95% confidence interval [CI], 2.30-4.80), femoral bruit (LR, 4.80; 95% CI, 2.40-9.50), or any pulse abnormality (LR, 3.10; 95% CI, 1.40-6.60). While none of the clinical examination features help to lower the likelihood of any degree of PAD, the absence of claudication or the presence of normal pulses decreases the likelihood of moderate to severe disease. When considering patients who are symptomatic with leg complaints, the most useful clinical findings are the presence of cool skin (LR, 5.90; 95% CI, 4.10-8.60), the presence of at least 1 bruit (LR, 5.60; 95% CI, 4.70-6.70), or any palpable pulse abnormality (LR, 4.70; 95% CI, 2.20-9.90). The absence of any bruits (iliac, femoral, or popliteal) (LR, 0.39; 95% CI, 0.34-0.45) or pulse abnormality (LR, 0.38; 95% CI, 0.23-0.64) reduces the likelihood of PAD. Combinations of physical examination findings do not increase the likelihood of PAD beyond that of individual clinical findings. However, when combinations of clinical findings are all normal, the likelihood of disease is lower than when individual symptoms or signs are normal. A PAD scoring system, which includes auscultation of arterial components by handheld Doppler, provides greater diagnostic accuracy. CONCLUSIONS: Clinical examination findings must be used in the context of the pretest probability because they are not independently sufficient to include or exclude a diagnosis of PAD with certainty. The PAD screening score using the hand-held Doppler has the greatest diagnostic accuracy.

Ankle↗
PubMed1996

The appearance of gallop rhythm after exercise stress testing.

BACKGROUND AND HYPOTHESIS: Although it is generally assumed that the appearance of an early diastolic gallop, or third heart sound, appearing immediately after exercise during treadmill stress testing, indicates the presence of serious myocardial disease, no systemically collected data are available to test this hypothesis. METHODS: The author performed auscultation on 3,679 patients undergoing routine treadmill testing together with thallium-201 perfusion scans. Exercise-induced diastolic sounds were related to the available clinical information and electrocardiographic and nuclear test results. These findings were compared with those of 665 randomly selected patients undergoing stress testing in whom such sounds were absent. RESULTS: A total of 165 patients had audible third heart sounds (Group 1). In comparison with those patients lacking such sounds (Group 2), there was a considerably greater prevalence of myocardial scarring (68.5 vs. 26.9%), abnormal lung uptake of thallium (40 vs. 12.8%), diabetes mellitus (20.6 vs. 6.2%), and left bundle-branch block on the resting electrocardiogram (ECG) (15.1 vs. 1.2%). In addition, 65 patients (39.3%) had dilatation of the left ventricle after exercise; 31 (18.8%) of these were also dilated at rest, but only 2 (1.2%) had a drop in blood pressure during stress. In those individuals also subjected to nuclear ventriculography, the average resting ejection fraction was 35%. Estimated exercise capacity was generally reduced in Group 1 (average peak of 6.6 METs), but 29 (17.6%) exceeded 9 METs. Sensitivity and specificity of electrocardiographic ST depression were relatively poor in the detection of perfusion defects within this group (36 and 62%, respectively). Of the 39 patients in Group 1 with a normal resting ECG, 19 (48.7%) had scar (usually posterior or lateral) on nuclear scans. In an additional 10 of this group, nuclear evidence of ischemia (often extensive) was found. CONCLUSIONS: An early or mid-diastolic gallop sound developing after exercise virtually always signifies myocardial disease with reduced myocardial function. Common associated findings are prior infarction (with or without associated ischemia), diabetes, and left bundle-branch block. When found in the presence of a normal resting ECG, this sound commonly signals the presence an occult left ventricular scar and, less commonly, extensive myocardial ischemia. In those patients manifesting such sounds, electrocardiographic ST changes in response to exercise appear limited in the detection of coronary ischemia.

Bundle-Branch Block↗
PubMed2004

A systolic murmur is a common presentation of aortic regurgitation detected by echocardiography.

BACKGROUND: The finding of aortic regurgitation at a classical examination is a diastolic murmur. HYPOTHESIS: Aortic regurgitation is more likely to be associated with a systolic than with a diastolic murmur during routine screening by a noncardiologist physician. METHODS: In all, 243 asymptomatic patients (mean age 42 +/- 10 years) with no known cardiac disease but at risk for aortic valve disease due to prior mediastinal irradiation (> or = 35 Gy) underwent auscultation by a noncardiologist followed by echocardiography. A systolic murmur was considered benign if it was grade < or = II/VI, not holosystolic, was not heard at the apex, did not radiate to the carotids, and was not associated with a diastolic murmur. RESULTS: Of the patients included, 122 (49%) were male, and 86 (35%) had aortic regurgitation, which was trace in 20 (8%), mild in 52 (21%), and moderate in 14 (6%). A systolic murmur was common in patients with aortic regurgitation, occurring in 12 (86%) with moderate, 26 (50%) with mild, 6 (30%) with trace, and 27 (17%) with no aortic regurgitation (p < 0.0001). The systolic murmurs were classified as benign in 21 (78%) patients with mild and 8 (67%) with moderate aortic regurgitation. Diastolic murmurs were rare, occurring in two (14%) with moderate, two (4%) with mild, and three (2%) with no aortic regurgitation (p=0.15). CONCLUSIONS: An isolated systolic murmur is a common auscultatory finding by a noncardiologist in patients with moderate or milder aortic regurgitation. A systolic murmur in patients at risk for aortic valve disease should prompt a more thorough physical examination for aortic regurgitation.

Adult↗
PubMedDate not supplied

Comparison of the lung sound frequency spectra of infants and adults.

Auscultation of the infant chest reveals lung sounds that seem different from those of adults. To characterize this subjective difference, we compared the phonopneumographic median frequencies of lung sounds of seven full-term and six premature infants with those of seven adults free of cardiopulmonary disease. The median frequencies over the upper lobes for the adults, term infants, and premature infants were 282 +/- 63(SD) Hz, 383 +/- 80 Hz, and 483 +/- 86 Hz, respectively. At this location the differences among the three groups were significant (p less than 0.01). Over the lower lobes, the median frequencies for the adults, term infants, and premature infants were 243 +/- 56 Hz, 386 +/- 76 Hz, and 390 +/- 63 Hz, respectively. Here the difference between the adults and both groups of infants was significant (p less than 0.01), but that between the term and premature infants was not. We conclude that the normal lung sounds of newborn infants contain higher-frequency components than those of adults. We postulate that this difference is the result of less filtering of the lung sound in infants. This difference should be considered when lung sounds of infants are described or assessed for the presence of abnormalities.

Adult↗
PubMed1994

Methodology for detecting swallowing sounds.

The use of cervical auscultation in the evaluation of the pharyngeal swallow may become a part of the clinical evaluation of dysphagic patients. Though its use is based on subjective evaluation, an acoustic analysis of swallowing sounds might establish more objective criteria in the detection of swallowing disorders. The present study sought to investigate three aspects of the methodology for detecting swallowing sounds: (1) the type of acoustic detector unit suited to an acoustic analysis of the pharyngeal swallow, (2) the type of adhesive suited for the attachment of the detector, and (3) the optimal site for sound detection of the pharyngeal swallow. An accelerometer with double-sided paper tape was selected as the appropriate detector unit because of its wide range of frequency response and small attenuation level. Using this detector unit, swallowing sounds and noise associated with simulated laryngeal elevation and the carotid pulse were acquired at 24 sites on the neck in 14 normal subjects; these signals were acoustically analyzed. The determination of the optimal site for detecting swallowing sounds was based on the signal-to-noise ratio. The site over the lateral border of the trachea immediately inferior to the cricoid cartilage is the optimal site for detection of swallowing sounds because this site showed the greatest signal-to-noise ratio with the smallest variance. The site over the center of the cricoid cartilage and the midpoint between the site over the center of the cricoid cartilage and the site immediately superior to the jugular notch were also considered to be the most appropriate sites.

Acceleration↗
PubMed1976

Mitral valve prolapse in children with secundum--type atrial septal defect (ASD II).

A left ventricular angiocardiogram for evaluation of the mitral valve in patients with uncomplicated secundum type atrial septal defect has been proposed in a recent paper by Victoria et al. (1974). These authors observed 8 children with a ballooning mitral valve and ASD II. They stressed the necessity of performing a left ventricular angiocardiogram in every patient with ASD II. To challange their proposal, the angiocardiograms of 78 children with secundum type ASD were reviewed. Of these 89 angios 34 were performed using the left ventricle (LV) as injection site while 55 times the injection was made in other parts of the heart, e.g. left atrium, pulm. art., right ventricle, right atrium. All 34 LV angios, but only 12 of the others allowed an evaluation of function and morphology of the mitral valve. Of the 46 angiocardiograms 27 (58.7%) revealed an intact, normally closing and opening mitral valve. In the remaining 19 (41.3%) various grades of ballooning or mild prolapsing of one or two leaflets of the mitral valve could be detected. The "scallops" were minimal in 12, moderate in 4 and pronounced in 3 cases. A mild regurgitation was seen in 1 patient only. No patient had the pronounced ballooning observed by Victoria et al. On auscultation only 1 case had the apical murmur of mitral regurgitation. The ECG of our 19 "positive" cases did not show signs of left atrial or left ventricular hypertrophy. A left axis deviation was found in 1 patient. During surgery no structural abnormality of the mitral valve was noted. Postoperative reevaluation of the mitral valve (including left ventricular contrast injection) in 10 cases revealed no change of mitral valve appearance in 8, a decrease of the ballooning in one, and an increase in another patient. It is concluded that prolapses of the mitral valve are seldom of such a degree as to cause dysfunction in children with secundum type ASD. The indications for performing a left ventricular injection of contrast material are the clinical signs of mitral valve regurgitation and/or left axis deviation in the ECG.

Child↗
PubMedDate not supplied

The vibratory innocent heart murmur in schoolchildren: difference in auscultatory findings between school medical officers and a pediatric cardiologist.

In 810 schoolchildren heart auscultation was performed by both a school medical officer (SMO) and a pediatric cardiologist (PC). The prevalence for a grade 1, 2, or 3 vibratory innocent heart murmur (VIHM), a grade 2 or 3 VIHM, and a grade 3 VIHM heard by the PC was 41%, 13%, and 1%, respectively. The SMO noted such murmurs in 26%, 9%, and 1%, respectively. In 30% of the cases in which the PC had noted a grade 2 or 3 VIHM, the SMO agreed; in 30% of such cases the SMO did not hear any heart murmur. If the PC heard a grade 2 or 3 VIHM phonocardiography was performed in a case-control study in which the controls did not have a heart murmur (94 pairs). In four children with a grade 2 or 3 VIHM no heart murmur could be registered and in three other children the murmur did not have the typical diamond shape. In contrast, in three children without a heart murmur at school a VIHM was seen on the phonocardiogram. In 26 children with a phonocardiographically proven grade 2 or 3 VIHM the SMO did not hear any heart murmur. One child with a grade 3 VIHM (both by the PC and SMO) had a minor subvalvular aortic stenosis. There is quite a difference in auscultatory detection of a venous hum: 9% (PC) and 2% (SMO). The prevalence of the pulmonary ejection murmur is identical at 4%. The carotid bruit is heard in 4% (PC) and 2% (SMO).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Diagnosing aortic valve stenosis by correlation analysis of wavelet filtered heart sounds.

Traditional auscultation performed by the general practitioner remains problematic and often gives significant results only in a late stage of heart valve disease. Valve stenoses and insufficiencies are nowadays diagnosed with accurate but expensive ultrasonic devices. This study aimed to develop a new heart sound analysis method for diagnosing aortic valve stenoses (AVS) based on a wavelet and correlation technique approach. Heart sounds recorded from 373 patients (107 AVS patients, 61 healthy controls (REF) and 205 patients with other valve diseases (OVD)) with an electronic stethoscope were wavelet filtered, and envelopes were calculated. Three correlations on the basis of these envelopes were performed: within the AVS group, between the groups AVS and REF and between the groups AVS and OVD, resulting in the mean correlation coefficients rAVS, rAVSv.REF and rAVSv.OVD. These results showed that rAVS (0.783 +/- 0.097) is significantly higher (p < 0.0001) than rAVSv.REF (0.590 +/- 0.056) and rAVSv.OVD (0.516 +/- 0.056), leading to a highly significant discrimination between the groups. The wavelet and correlation-based heart sound analysis system should be useful to general practitioners for low-cost, easy-to-use automatic diagnosis of aortic valve stenoses.

Adult↗
PubMed2005

Computerised analysis of auscultatory sounds associated with vascular patency of haemodialysis access.

Vascular access for renal dialysis is a lifeline for about 120 000 individuals in the United States. Stethoscope auscultation of vascular sounds has some utility in the assessment of access patency, yet can be highly skill-dependent. The objective of the study was to identify acoustic parameters that are related to changes in vascular access patency. The underlying hypothesis is that stenoses of haemodialysis access vessels or grafts cause vascular sound changes that are detectable using computerised data acquisition and analysis. Eleven patients participated in the study. Their vascular sounds were recorded before and after angiography, which was accompanied by angioplasty in most patients. The sounds were acquired using two electronic stethoscopes and then digitised and analysed on a personal computer. Vessel stenosis changes were found to be associated with changes in acoustic amplitude and/or spectral energy distribution. Certain acoustic parameters correlated well (correlation coefficient = 0.98, p < 0.0001) with the change in the degree of stenosis, suggesting that stenosis severity may be predictable from these parameters. Parameters also appeared to be sensitive to modest diameter changes (> 20%), (p < 0.005, Wilcoxon rank sum test). These results suggest that computerised analysis of vascular sounds may be useful in vessel patency surveillance. Further testing using longitudinal studies may be warranted.

Arteriovenous Shunt, Surgical↗
PubMed2005

Detection of the third heart sound using a tailored wavelet approach: method verification.

Heart sounds can be considered as mechanical fingerprints of myocardial function. The third heart sound normally occurs in children but disappears with maturation. The sound can also appear in patients with heart failure. The sound is characterised by its low-amplitude and low-frequency content, which makes it difficult to identify by the traditional use of the stethoscope. A wavelet-based method has recently been developed for detection of the third heart sound. This study investigated if the third heart sound could be identified in patients with heart failure using this detection method. The method was also compared with auscultation using conventional phonocardiography and with characterisation of the patients with echocardiography. In the first study, 87% of the third heart sounds were detected using the wavelet method, 12% were missed, and 6% were false positive. In study 2, the wavelet-detection method identified 87% of the patients using the third heart sound, and regular phonocardiography identified two (25%) of the subjects.

Adult↗
PubMed1995

Design and application of sensor for recording sounds over human eye and nose.

The recording of sounds over the orbit of the eye has been found to be useful in the detection of intracranial aneurysms. A hydrophone for auscultation over the eye has been developed and is tested under controlled conditions. The tests consist of measurement over the eyes in three healthy volunteers at rest, during voluntary breathing, during eyeball movements and during sustained orbicular muscular contractions. Furthermore, measurements are performed at the side of the nose. Major features of the hydrophonic transducer are high sensitivity to physiological sounds and a high degree of insensitivity to environmental sounds propagated through the air. It can be concluded that the hydrophone may be useful for the early detection of intracranial aneurysms and also for apnoea detection.

Auscultation↗
PubMedDate not supplied

Cost effectiveness in the detection of renal artery stenosis.

Cost effectivenesses of four tests for diagnosing renal artery stenosis were examined. Sensitivity, specificity, cost per patient, and cost per stenosis found for a variety of diagnostic strategies using these tests were retrospectively evaluated using clinical data from 605 hypertensive patients. Cost effectiveness of a given strategy was found to depend on the sequence in which the tests were performed, but to be relatively independent of the exact cost of the tests. Auscultation for a systolic/diastolic abdominal bruit was the most cost-effective test for beginning a diagnostic strategy and showed a 99.6% specificity for stenosis. When the patient has a systolic bruit only or no bruit, plasma renin activity measurement should guide the clinician's choice of whether to test further with intravenous pyelography or renal arteriography. Diagnosis of renal artery stenosis using these tests is estimated to cost between $2,300 and $6,200 per stenosis found, depending on the prevalence of renal artery stenosis.

Adult↗
PubMed1990

Passive warming of airway gases (artificial nose) improves accuracy of esophageal temperature monitoring.

The most efficient site for monitoring heart and lung sounds by esophageal stethoscope is not the warmest segment of the esophagus. This study investigated the ability of passive warming of airway gases to increase the accuracy of temperatures measured at this site (i.e., to decrease their difference from core temperature). In 15 adult patients undergoing general anesthesia and endotracheal intubation, esophageal temperatures were measured before and after use of a heat and moisture exchanger (an artificial nose) that passively warmed inspired gases. The resulting values were compared with nasopharyngeal temperatures, which represented core temperature. Before use of the heat and moisture exchanger, esophageal and nasopharyngeal temperatures differed significantly (mean difference +/- SD, 0.9 +/- 0.4 degrees C; P less than or equal to 0.001). After passive warming of inspired gases, esophageal temperatures increased significantly (mean increase +/- SD, 0.5 +/- 0.2 degrees C; P less than or equal to 0.001) but inconsistently (range, 0.1 to 1.2 degrees C). However, the mean difference between esophageal and nasopharyngeal temperatures was still significant (0.5 +/- 0.3 degrees C; P less than 0.001). Discrepancies between esophageal and core temperatures persist when a currently available esophageal stethoscope with adjacent auscultation chamber and temperature probe is used, despite passive warming of airway gases.

Adult↗
PubMed2001

[Development of modern physical diagnosis and its application in cardiothoracic surgery].

The year 2000 marked the 300th anniversary of the birth of Gerard Van Swieten (1700-1772). He reformed medicine in Vienna, putting new emphasis on diagnosis based on clinical observation in combination with anatomical-pathological findings. This led to the introduction by Leopold Auenbrugger (1722-1809) of percussion in the examination of thoracic organs. However, further work by Joseph Skoda (1805-1881) was required to finally establish this method as a diagnostic tool for pathologies in the thorax. The surgeon Franz Schuh (1804-1865) carried out further basic research in respiratory physiology that cleared the way for the use of percussion and auscultation in thoracic surgery. He is also remembered for introducing experimental surgery in Austria, thus making surgery a science. This article aims to recall these men and their fundamental work behind early paracentesis of the thorax, and especially the first successful pericardiotomy by Schuh 160 years ago, which is also considered a milestone in cardiac surgery.

Auscultation↗
PubMed2006

[The bicentenary of Josef Skoda's birth (1805-1881). An innovator in the field of the physical examination].

The bicentenary of Josef Skoda's birth (December 10(th) 2005) was seen as an excellent opportunity to review his accomplishments for internal medicine. He extended the physical examination, namely percussion and auscultation, and established the scientific basis for these techniques. While Skoda's predecessors interpreted sounds and murmurs by natural philosophy and phenomenologically, Skoda established diagnoses based on empirical and experimental investigations. He compared diagnostic findings with post mortem results at Rokitansky's morgue. Thus, Skoda's work led to the modern capabilities of the physical examination.

Auscultation↗