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PubMed1979

Supraorbital Doppler studies, carotid bruits, and arteriography in unilateral ocular or cerebral ischemic disorders.

In 122 patients with unilateral brain or ocular ischemia, supraorbital Doppler studies revealed evidence of obstruction in 44 of 51 common or internal carotid arteries having greater than 70 percent stenosis, and in only 4 of 23 arteries with 50 to 70 percent stenosis. Ipsilateral bruits were present in 52 of 74 carotid arteries with greater than 50 percent stenosis, and in 19 of 37 arteries with less than 50 percent stenosis. Only one false-positive Doppler result occurred, and only 15 false-positive midcervical bruits were present in 129 normal carotid arteries. Unfortunately, these studies do not decrease the need for radiopaque arteriography, since in 11 of 53 patients, a potentially operable, symptomatic, nonobstructive common or internal carotid artery lesion would not have been suspected by supraorbital Doppler testing and auscultation alone.

Angiography↗
PubMed2005

Automatic wheeze detection based on auditory modelling.

Automatic wheeze detection has several potential benefits compared with reliance on human auscultation: it is experience independent, an automated historical record can easily be kept, and it allows quantification of wheeze severity. Previous attempts to detect wheezes automatically have had partial success but have not been reliable enough to become widely accepted as a useful tool. In this paper an improved algorithm for automatic wheeze detection based on auditory modelling is developed, called the frequency- and duration-dependent threshold algorithm. The mean frequency and duration of each wheeze component are obtained automatically. The detected wheezes are marked on a spectrogram. In the new algorithm, the concept of a frequency- and duration-dependent threshold for wheeze detection is introduced. Another departure from previous work is that the threshold is based not on global power but on power corresponding to a particular frequency range. The algorithm has been tested on 36 subjects, 11 of whom exhibited characteristics of wheeze. The results show a marked improvement in the accuracy of wheeze detection when compared with previous algorithms.

Algorithms↗
PubMed1980

A point-score system for the differential diagnosis between idiopathic cardiomyopathy and ischemic heart disease.

A point-score system made from sympatoms, electrocardiographic findings, auscultation, and chest X-ray has been presented for the differential diagnosis among congestive cardiomyopathy, hypertrophic cardiomyopathy and ischemic heart disease. This system involved a multivariate analysis of 188 cases in which the diagnoses were established by typical echocardiographic findings, invasive examinations or autopsies. The accuracy of diagnosis by this point-score system was 91.5%. This point-score system appears to be useful as a screening test in differentiating idiopathic cardiomyopathy from ischemic heart disease.

Adolescent↗
PubMed2004

Accuracy of detecting irregular cardiac rhythms via telemedicine.

We evaluated the accuracy of an electronic stethoscope in the detection of irregular cardiac rhythms. Ten patients with either normal sinus rhythm or atrial fibrillation previously documented by electrocardiogram (ECG) were recruited from a local retirement community. Six senior family medicine resident physicians were asked to assess the cardiac rhythms of the subjects as either regular or irregular, in both a telemedical and an in-person examination. An ECG was obtained simultaneously as the gold standard. Forty-five of the 60 in-person assessments were correct, as were 49 of the 60 telemedicine assessments. The difference was not significant. Physician confidence in telemedical examination did not affect the accuracy of examination. The results of this study suggest that telemedicine-directed auscultation of patients may be just as successful as inperson examination for the detection of cardiac arrhythmias.

Aged↗
PubMedDate not supplied

The process of conducting a physical assessment: a nursing perspective.

Physical assessment is a new responsibility for many nurses in the UK who are expanding their parameters of advanced clinical practice. A physical assessment framework can be used by both community and acute care nurses as a guide to the process of conducting a physical assessment. The framework presented here consists of the following sequence of steps: identifying the purpose of the assessment; taking a health history; choosing a comprehensive or focused approach; and examining the patient using the sequence of inspection, palpation, percussion and auscultation. The next step, interpretation of the clinical findings, which results in either the recognition of abnormality or identification of a differential diagnosis, then becomes the basis for clinical decision making. This paper describes a comprehensive, head-to-toe assessment as one example of the application of this physical assessment framework in clinical practice.

Auscultation↗
PubMed2002

Henry Ingersoll Bowditch and Oliver Wendell Holmes: stethoscopists and reformers.

Two Bostonians, Henry Ingersoll Bowditch (1808-1892) and Oliver Wendell Holmes (1809-1894), went to Paris for advanced medical training and came home ardent disciples of Pierre Charles Alexandre Louis, leader of the French school that derived its eminence from expert auscultation and careful correlation of bedside and autopsy findings. Both Bowditch and Holmes became leaders in 19th-century American medicine. Bowditch, a successful practitioner and prolific medical writer, wrote the first important American text on physical examination and became our first specialist in pulmonary disease. He pioneered in the public health movement, was a charter member and later president of the American Medical Association, and was an abolitionist and an advocate for equal rights for women in medicine. Holmes left practice to become a medical educator. As Dean of Harvard Medical School, he tried unsuccessfully to admit white women and free black men to the school. Although his greatest fame came as a man of letters, Holmes considered himself first a physician and medical educator, and was justifiably proud of his definitive study, "The Contagiousness of Puerperal Fever" (1843). Today, Bowditch and Holmes are little appreciated as pioneers and reformers, but we remain in debt to them both.

Auscultation↗
PubMed1993

Measurement of respiratory acoustical signals. Comparison of sensors.

We assessed the performance of three air-coupled and four contact sensors under standardized conditions of lung sound recording. Recordings were obtained from three of the investigators at the best site on the posterior lower chest as determined by auscultation. Lung sounds were band-pass filtered between 100 and 2,000 Hz and sampled simultaneously with calibrated airflow at a rate of 10 kHz. Fourier techniques were used for power spectral analysis. Average spectra for inspiratory sounds at flows of 2 +/- 0.5 L/s were referenced against background noise at zero flow. Air-coupled and contact sensors had comparable maximum signal-to-noise ratios and gave similar values for most spectral parameters. Unexpectedly, less sensitivity (lower signal-to-noise ratio) at high frequencies was observed in the air-coupled devices. Sensor performance needs to be characterized in studies of lung sounds. We suggest that lung sound spectra should be averaged at known airflows over several breaths and that all measurements should be reported relative to sounds recorded at zero flow.

Adult↗
PubMed1994

Rapid clinical diagnosis of pulmonary abnormalities in HIV-seropositive patients by auscultatory percussion.

A prospective, blinded study of pulmonary findings in hospitalized patients with HIV infection compared auscultatory percussion (AusP) with conventional percussion (ConP) and conventional auscultation (ConA) using chest radiographs as the gold standard. Sixty-three patients had chest radiographs and were examined by one to three examiners. Seventy of the 126 lungs had radiographic abnormalities (55.6 percent). Auscultatory percussion proved to be the most sensitive of all techniques for each examiner (range, 51.0 to 69.6 percent) for detecting radiographic abnormalities and also had higher likelihood ratios for two of the three examiners; AusP also had the highest likelihood ratio pooled across examiners. Of the 166 abnormal results of lung examinations, the combination of AusP and ConA detected 31 more abnormalities than ConP and ConA combined, with 14 of these being diagnosed with Pneumocystis carinii pneumonia. No abnormalities were detected by ConP that were not detected by AusP. These findings suggest that AusP, a rapid clinical maneuver, is more sensitive and specific than ConA and ConP in determining pulmonary abnormalities in HIV-infected inpatients.

Adult↗
PubMed2001

Auditory detection of simulated crackles in breath sounds.

BACKGROUND: Computerized analysis of breath sounds has relied on human auditory perception as the reference standard for identifying crackles. In this study, we tested the human audibility of crackles by superimposing artificial clicks on recorded breath sounds and having physicians listen to the recordings to see if they could identify the crackles. OBJECTIVES: To establish the audibility of simulated crackles introduced in breath sounds of different intensity, to study the effects of crackle characteristics on their audibility, and to investigate crackle detection within and between observers. METHODS: Fine, medium, and coarse crackles with large and small amplitude were synthesized by computer software. Waveform parameters were based on published characteristics of lung sound crackles. The amplitude for small crackles was defined as just above the threshold of audibility for simulated crackles inserted in sound recorded during breath hold. Simulated crackles were then superimposed on breath sounds recorded at 0 L/s (breath hold), 1 L/s, and 2 L/s airflow. Five physicians listened during playback on two separate occasions to determine if crackles could be heard and to calculate the interobserver and intraobserver variations. RESULTS: Failed detection of crackles was significantly more common in the following conditions: (1) background breath sounds had higher intensity (2 L/s airflow) compared to lower intensity (1 L/s), (2) crackle type was coarse or medium compared to fine, and (3) crackle amplitude was small compared to large. Both intraobserver and interobserver agreements were high (kappa > 0.6). RELEVANCE: The validation of automated techniques for crackle detection in lung sound analysis should not rely on auscultation as the only reference. Detection of crackles is facilitated when patients take slow, deep breaths that generate little breath sounds.

Auditory Perception↗
PubMed2004

Mastering cardiac murmurs: the power of repetition.

BACKGROUND: The ability of medical students to recognize heart murmurs is poor (20%), and does not improve with subsequent years of training. A teaching method to improve this skill would be useful. STUDY OBJECTIVES: To determine whether intensive repetition of four basic cardiac murmurs improves auscultatory proficiency in medical students. DESIGN: Controlled intervention study. SUBJECTS: Fifty-one second-year medical students in an east coast medical school. INTERVENTIONS: Subjects were classified into three groups: (1) a monitored group, who listened to 500 repetitions of each murmur in a monitored setting, (2) an unmonitored group, who listened to 500 repetitions of each murmur in an unmonitored setting, and (3) a control group. All three groups were tested using a pretest and posttest methodology. MEASUREMENTS AND RESULTS: The 20 subjects in the monitored group improved from 13.5 +/- 9.8 to 85 +/- 17.6% following the intervention (mean +/- SD). Similarly, 21 students in the unmonitored group improved from 20.9 +/- 10.9 to 86.1 +/- 15.6%. Ten control students showed no significant improvement (24 +/- 21.7 to 32 +/- 22.5%). The differences between the two intervention groups and the control subjects was significant at p < 0.001 by analysis of variance. CONCLUSION: Five hundred repetitions of four basic cardiac murmurs significantly improved auscultatory proficiency in recognizing basic cardiac murmurs by medical students. These results suggest that cardiac auscultation is, in part, a technical skill.

Cardiology↗
PubMed1975

The effect of isometric exercise on the systolic murmur of patients with idiopathic hypertrophic subaortic stenosis.

The effect of isometric handgrip exercise on the systolic murmur and bifid pulse in patients with idiopathic hypertrophic subaortic stenosis (IHSS) was evaluated. During handgrip exercise, the systolic murmur became inaudible or decreased in intensity by auscultation and disappeared or decreased in amplitude in phonocardiographic recordings in nine of nine patients with IHSS. During handgrip exercise, the bifid pulse observed in seven patients with IHSS disappeared or markedly decreased. Handgrip exercise may be helpful in the bedside diagnosis of IHSS.

Adult↗
PubMed1976

Acquired continuous murmur associated with acute pulmonary thromboembolism.

Two cases of a continuous murmur following an acute pulmonary embolic episode are presented, and eight previously reported cases with an acquired postembolic continuous murmur (found in a review of the literature) are discussed. This finding is present in both chronic and acute pulmonary embolism and is suggestive of significant embolic obstruction. Although the continuous murmur is an unusual sign in patients with pulmonary embolism, its auscultation is often quite distinctive, and its appearance may lead to more definitive diagnostic studies when the presentation or associated clinical findings are nonspecific.

Acute Disease↗
PubMed1978

Diastolic rumbles in normally functioning porcine mitral valves.

Fourteen of 22 patients (64%) with normally functioning porcine prosthetic valves in the mitral position had apical diastolic rumbles on phonocardiogram and by auscultation. Six (27%) had opening snaps. Factors necessary for the production of a diastolic rumble appear to include central flow, a flexible stent, and the presence of biologic material. Clinicians should be aware that diastolic murmurs and snaps occur in the normally functioning porcine valve.

Adolescent↗
PubMed1987

Loud systolic and diastolic murmurs originating on a right atrial metastatic tumor.

A 36-year-old asymptomatic man, who two months before had a normal clinical examination, developed two loud, grade 5/6 harsh systolic and diastolic murmurs, audible over the entire precordium. Two-dimensional echocardiography revealed a huge tumoral mass, attached to the right atrium near the tricuspid valve, pedicellated and of great mobility, reaching the right ventricular outflow tract during diastole, and coming back to the atrium in systole. Right-sided angiography confirmed the diagnosis, and after ablation of the tumor, the auscultation was normal again. Two loud murmurs constitute a quite uncommon manifestation of an intracavitary mass, and this unusual finding has not previously reported in the medical literature available to the authors.

Adult↗
PubMed1988

Increased mitral valve insufficiency during precordial "whoop".

A patient with rheumatic mitral valve stenosis and regurgitation presented with shortness of breath and a "noise" in her chest. Cardiac auscultation revealed an intermittent late systolic "whoop." An increase in severity of mitral valve insufficiency during the periods of "whoop" was observed by pulsed Doppler, hemodynamic tracings and left ventriculography.

Aged↗
PubMed1990

Measuring crackles.

Crackles heard on auscultation can be represented graphically as a time-amplitude plot of the associated waveform. To assess the relative merits of several measures which might be considered for machine implementation in diagnostic instruments, we compared the reproducibility of those based on the initial voltage deflection which begins a crackle with those based on the largest deflection. The latter group showed less interobserver and less intraobserver variability when the same crackles were measured twice by each of two observers. Crackles from a teaching tape, categorized as fine and coarse, were used in this study. The ability of the various measures tested to distinguish between fine and coarse crackles on an individual basis was assessed and found to favor the measures based on the largest deflection. They showed an average of 9.96 percent incorrectly classified crackles, as opposed to 19.53 percent for the two measures based on the initial deflection.

Auscultation↗
PubMed1990

[Phonographic diagnostic aid in heart defects using neural networks].

New approaches to pattern recognition and modeling using neural networks also provide powerful tools for the analysis of heart sounds in the diagnosis of heart failure. This paper describes how a neutral network can be used to estimate the duration of systolic and diastolic heart phases as well as to suggest a suitable diagnosis. A neural network-based auscultation system is capable of documenting and analysing a heart sound signal by applying methods similar to those used by physicians in the subjective interpretation of stethoscopic signals.

Diagnosis, Computer-Assisted↗
PubMed2002

Detection of bronchial breathing caused by pneumonia.

The classic auscultation with stethoscope is the established clinical method for the detection of lung diseases. The interpretation of the sounds depends on the experience of the investigating physician. Therefore, a new computer-based method has been developed to classify breath sounds from digital lung sound recordings. Lung sounds of 11 patients with one-sided pneumonia and bronchial breathing were recorded on both the pneumonia side and on contralateral healthy side simultaneously using two microphones. The spectral power for the 300-600 Hz frequency band was computed for four respiratory cycles and normalized. For each breath, the ratio R between the time-segments (duration = 0.1 s) with the highest inspiratory and highest expiratory flow was calculated and averaged. We found significant differences in R between the pneumonia side (R = 1.4 +/- 1.3) and the healthy side (R = 0.5 +/- 0.5; p = 0.003 Wilcoxon-test) of lung. In 218 healthy volunteers we found R = 0.3 +/- 0.2 as a reference-value. The differences of ratio R (delta R) between the pneumonia side and the healthy side (delta R = 1.0 +/- 0.9) were significantly higher compared to follow-up studies after recovery (delta R = 0.0 +/- 0.1, p = 0.005 Wilcoxon-test). The computer based detection of bronchial breathing can be considered useful as part of a quantitative monitoring of patients at risk to develop pneumonia.

Auscultation↗