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Family Practice Vol. 19, No. 4, 422-425
© Oxford University Press 2002

Selections from Current Literature

Horton hears a Who but no murmurs— does it matter?

Colin P Kopes-Kerr

Department of Family Medicine, Health Sciences Center L-4, 050, SUNY at Stony Brook, Stony Brook, NY 11794, USA.

Kopes-Kerr CP. Horton hears a Who but no murmurs—does it matter? Family Practice 2002; 19: 422–425.

The first 150 words of the full text of this article appear below.

Introduction to the cardiac auscultation problem

Schneiderman H. Cardiac ausculation and teaching rounds: how can cardiac ausculation be resuscitated?Am J Med 2001; 110: 233–235.[Web of Science][Medline]

A recent editorial in the American Journal of Medicine laments that cardiac auscultation skills appear to be heading for extinction. To reach this conclusion, one has to concur with two implicit assumptions: (i) at some time in the illustrious past of medicine, there was a moment when physicians were good at this skill and we have somehow declined from that peak; and (ii) that this matters—either to patients or to physicians in terms of outcomes—that somehow significant numbers of patients hover on the brink of catastrophe due to failure of auscultatory diagnosis. Let us examine for a moment some of the relevant literature to see if this is actually the case.

Background: what is the recorded history of cardiac auscultation skills?

Lembo NJ, Dell'Italia LJ, Crawford MH, O'Rourke RA. Bedside diagnosis of systolic murmurs.N Engl J Med 1988; 318: . . . [Full Text of this Article]

Modern clinical studies

Cardiologists' auscultatory exams
Paediatricians' auscultatory exams
Generalists' auscultatory exams
Other cardiac sounds
Analysis

Is there a problem? If so, have we defined it correctly? What is it worth doing about it?
When is cardiac auscultation worthwhile in primary care and what should we be seeking to learn?

Conclusion


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