Enhanced auscultation with a new graphic display system

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.

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.

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.

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.