Auscultation overview

Place of echocardiography in clinical examination

There is variation in individual auscultatory skill

• More than 50% of common heart sounds and murmurs were misdiagnosed by medical students and residents.
• Graphic documentation of auscultatory findings is no longer being obtained.
• Evidence base for using auscultatory findings is limited and may not justify the time and money required to teach true proficiency.

Important goal is not to miss valvular heart disease.

• Learning normal auscultory findings may be easiest.
• When auscultation is abnormal in a SYMPTOMATIC patient, echocardiography is generally indicated.
• When an asymptomatic patient has evidence of significant cardiac disease, echocardiography is generally indicated.
• The feedback provided by appropriate ordering of echocardiography should permit individuals to improve their auscultatory skills as they care for patients.

Disclaimer: Material is for discussion & review and is not advice or endorsement. Comments to Donald Vine MD.