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PubMedDate not supplied

[Measurement of the frequency response of several stethoscopes in common use. Consequences for cardiac and pulmonary auscultation].

We measured the frequency response of eight stethoscope membranes and of thirteen types of stethoscopes. Measurements were made in an anechoic chamber calculating the ratio between the intensity of a sinusoidal sound coming from a loud speaker and the intensity of the transmitted sound through the membrane of the stethoscope. Small membranes have a bandwidth (without attenuation or amplification) between 10 and 600 Hz while large membranes have a bandwidth twice the size (10-1200 Hz). This good result does not appear in the case of stethoscopes showing increasing attenuation versus frequency, with a mean value from -2.5 to -10.5 dB and variations of 10 dB in the range 50-1200 Hz which is the useful bandwidth for cardiac and pulmonary auscultation. By contrast, fidelity of the measured stethoscopes was good. Discussion of the results suggests modification of stethoscope design to eliminate faults of sound transmission and to elaborate a microphone sensor allowing an electric transmission.

Auscultation↗
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

[Comparison of auscultation findings using a classic stethoscope (Litmann 2120) and electronically amplified stethoscope (Medmax2)].

Heart auscultation has one of the key roles in beside diagnosis, especially in patients with cardiovascular diseases. Sometimes, because of the human cars' low sensitivity, a problem emerges in the proper evaluation of heart sounds and murmurs of lower frequencies. Our study compared two stethoscopes, the classic acoustic stethoscope (Littmann 2120) and an electronic one with the sound amplifier and the noise filtering system (Medmax2) in 10 patients examined by 10 physicians. Significantly better detection of low frequency sounds was found in favour of electronic stethoscope (chi 2 = 17.9; p < 0.0001). It is concluded that the selective amplificator improves the stethoscope performance and has its place in everyday bedside practice, especially in departments of cardiology.

Aged↗
PubMed1987

Postural cardiovascular reflexes: comparison of responses of forearm and calf resistance vessels.

Simultaneous measurements were made of changes in vascular resistance in the forearm and calf in response to moving from supine to sitting or to head-down tilt. The subjects were healthy male volunteers, 21-63 yr. Blood flows were measured by venous occlusion plethysmography using mercury-in-Silastic strain-gauges. The gauges were maintained at the same level relative to the heart during the postural changes. Arterial blood pressure was measured by auscultation; heart rate was counted from the plethysmograms. Changing from supine to sitting caused a decrease in forearm blood flow from 4.13 +/- 0.14 to 2.16 +/- 0.19 ml.100 ml-1.min-1. Corresponding calf flows were 4.21 +/- 0.32 and 4.40 +/- 0.59 ml.100 ml-1.min-1. There was no change in mean arterial blood pressure, and heart rate increased by 8.0 +/- 1.5 beats/min. Arrest of the circulation of both legs with occlusion cuffs on the thighs before sitting, to prevent pooling of blood in them, reduced the degree of forearm vasoconstriction. Neck suction (40 Torr) during sitting, to oppose the decrease in transmural pressure at the carotid sinuses, inhibited the vasoconstriction. During a 30 degrees head-down tilt, there was a dilatation of forearm but not of calf resistance vessels. A Valsalva maneuver caused a similar constriction of both vascular beds. Thus, when changes in vascular resistance in forearm and calf are compared, the major reflex adjustments to changes in posture take place in the forearm.

Adult↗
PubMed2001

Teaching cardiac auscultation using simulated heart sounds and small-group discussion.

BACKGROUND AND OBJECTIVES: Several educators have reported poor identification of abnormal cardiac sounds by primary care residents. Practice and review with cardiology patient simulators and prerecorded heart sounds has been shown to increase the accuracy of diagnosis by medical students and residents. METHODS: The participants were 15 members of an urban family practice residency. The residents were presented with simulated heart sounds and were asked to identify them in a pretest and posttest. Between the tests, participants were invited to three separate teaching sessions that involved a discussion of cardiac auscultatory findings and a review of audiotaped similar heart sounds. Residents who were unable to attend the teaching sessions formed a control group. RESULTS: The pretest identification rate was 36% for the heart sounds. This improved to 62% for all residents after the intervention. Higher rates of improvement were demonstrated by the residents who attended one or more teaching sessions, compared with the residents who attended no teaching sessions. CONCLUSIONS: Small-group discussion and repetitive auscultation of simulated heart sounds can improve the cardiac auscultatory proficiency of family practice residents.

Education, Medical, Undergraduate↗
PubMed1998

Auscultation of the heart: a trial of classroom teaching versus computer-based independent learning.

Declining skills in auscultation of the heart prompted an evaluation of teaching methods for medical students. A comparison of classroom teaching and computer-aided independent learning of auscultation was carried out with two groups of approximately 20 second-year medical students. Both groups used approximately 20 recorded normal and abnormal heart sounds and murmurs, chosen to illustrate learning issues. For the classroom group a cardiologist presented each case through multiple stethophones and led the discussion. The individual study group used a new CD-ROM collection of cases and recordings in quiz format, with a hypertext link to a comprehensive text on auscultation and additional recordings. Students were tested with 16 multiple choice and 5 open questions on eight selected recordings, and evaluated the teaching by questionnaire. The classroom-taught students scored higher on open questions than the CD-ROM-taught group, but in general performance by both groups was satisfactory and equivalent. Students of both groups repeatedly had difficulty classifying regurgitant and ejection murmurs and identifying characteristics of the second heart sound. Both CD-ROM and classroom teaching methods were highly rated by students but most students preferred a combination.

CD-ROM↗