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The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
You may see experienced practitioners using skills of cardiac auscultation; this can identify abnormalities of blood flow through the valves in the heart. Closing of the heart valves generates sounds that can be heard when placing a stethoscope in key areas of the chest. The clearest sounds are S1 (1st heart sound), generated by the closure of the mitral and tricuspid valve, signalling the onset of systole, and S2 (2nd heart sound), generated by the closure of the aortic and pulmonary valves, signalling the beginning of diastole. S1 and S2 can be heard in each of the 4 assessment areas (see Figure 6.1). Normal blood flow is not usually heard, but in some instances, for example, with a damaged stenotic and/or leaky valve, the turbulent blood flow through the diseased valve produces murmurs that can be heard in the quiet time between systole and diastole (S1 and S2) (Bickley 2017). Any added sounds (to S1 and S2), systolic or diastolic murmurs should be reported for further evaluation.
From listening to hearing
Published in Alan Bleakley, Educating Doctors’ Senses Through the Medical Humanities, 2020
Sanjiv Kaul (2014), in an editorial for Echo Research and Practice, says: “It is time to discard the inaccurate albeit iconic stethoscope and join the rest of mankind in the technology revolution!” He suggests that technologies such as pocket ultrasound devices will inevitably supplant the stethoscope for cardiac investigations. But also, while medical students and junior doctors consistently remain poor at identifying cardiac abnormalities – typically recognising less than 40% of heart sounds heard through cardiac auscultation – and where simulation training does not help (Finley 2011), let’s face the music and adapt. Similar calls have been made since at least the beginning of the new millennium. Fredriksen (2002), however, says: “the stethoscope is not obsolete. It is still a central part of medical practice”.
Perioperative cardiovascular evaluation and treatment of elderly patients undergoing noncardiac surgery
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Dipika Gopal, Monika Sanghavi, Lee A. Fleisher
A complete preoperative physical examination is necessary for every patient undergoing noncardiac surgery. Blood pressure and heart rate should be determined in both the supine and standing positions to assess intravascular volume status or autonomic dysfunction. Careful cardiac auscultation should be performed to detect clinically important cardiac findings, including the presence of an S3 gallop suggestive of HF and murmurs suggestive of significant valvular disease, particularly aortic stenosis. The pulmonary exam and evaluation of the jugular venous pulsations and lower extremity edema can also help determine intravascular volume status and the presence of HF. Peripheral arterial pulses that are diminished, or bruits may suggest peripheral vascular disease or the presence of occult atherosclerotic disease.
Digitalising medical education: sacrificing skills for knowledge?
Published in Medical Education Online, 2019
Cardiac auscultation is a subtle sensory skill that is often found difficult by many medical students. As such, using technological aids in teaching this topic have been trialled for many years. As early as 1991, Mangione et al. [2]. demonstrated that computer-assisted instruction with graphics and digitised heart sounds was just as effective as seminars at improving the identification of murmurs by students. These early studies, however, were focused on improving the understanding of cardiac auscultation in a classroom setting. The handheld echocardiogram (HHE) and digital stethoscope technique used by Leggett, on the other hand, enable students to engage with real patients whilst following a structured approach to understanding murmurs. The privilege of being able to auscultate a patient and then playback the murmur allows reinforcement of the knowledge gained from the experience. It takes a step away from the commonly heard and frustratingly vague notion that the ability to distinguish heart murmurs ‘comes with time’. Furthermore, the inability to standardise the sounds heard by teacher and student in traditional bedside teaching can cause a misinterpretation effect, where the student may alter their recollection of the sounds they heard on auscultation to fit the description of the teacher. This can lead to confusion and a lack of self-confidence in auscultation. Digital stethoscopes mitigate this effect.
Digital devices for teaching cardiac auscultation - a randomized pilot study
Published in Medical Education Online, 2018
Malcolm E. Legget, MeiYen Toh, Andries Meintjes, Sarah Fitzsimons, Greg Gamble, Robert N. Doughty
Digital stethoscopes and hand-held echocardiography (HHE) devices are modern portable digital devices that allow physicians to evaluate patients with heart murmurs. Digital stethoscopes provide improved sound quality and the ability to record and play back sounds multiple times to multiple listeners [1]. HHE devices provide real-time visual display of cardiac valvular pathology at the patient bed-side. While well established as tools that help in the clinical assessment of patients, these tools also have the potential to facilitate effective teaching of cardiac auscultation, a core skill integral to clinical medicine. A conventional stethoscope’s inability to act as an ‘audio platform’ may be a significant obstacle to the effective teaching of cardiac auscultation [1]. The use of digital stethoscopes and HHE as teaching aids to improve the diagnostic accuracy of evaluation of heart murmurs, compared to conventional bedside examination, has not yet been evaluated in depth.
Secondary erythrocytosis
Published in Expert Review of Hematology, 2023
Rodrick Babakhanlou, Srdan Verstovsek, Naveen Pemmaraju, Cristhiam M. Rojas-Hernandez
Although measurement of arterial oxygen saturation (SaO2) is a sensitive indicator of tissue hypoxia, results should be interpreted with caution in patients with carbon monoxide poisoning or sleep apnea, as results can be misleading [6]. Cardiac auscultation may reveal the presence of murmurs or abnormal heart sounds, which can be suggestive of an underlying cardiac condition with a right-to-left shunt [1]. The presence of clubbing of the fingers, decreased breath sounds, and the presence of a barrel chest may indicate emphysematous changes of the lung [1]. Abdominal examination should focus on the presence of any mass, as various benign and malignant tumors can give rise to secondary erythrocytosis as a paraneoplastic manifestation [1].