The echocardiography and assessment of cardiac auscultation

Postgraduate Thesis uoadl:1311715 435 Read counter

Κατεύθυνση Εργαστηριακή και Κλινική Νοσηλευτική Καρδιολογία
Library of the School of Health Sciences
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Οικονομίδης Ιγνάτιος
Original Title:
Η ηχωκαρδιογραφία και αξιολόγηση της καρδιακής ακρόασης
Translated title:
The echocardiography and assessment of cardiac auscultation
Purpose: In the present study we assessed the diagnostic accuracy of the
cardiac examination with an emphasis on cardiac auscultation in a significant
number of patients who had or no a murmur or another additional heart sound of
unknown cause using the echocardiography as the gold standard examination
method.Μethods: The study included 179 patients who were firstly referred for a
clinical examination and secondly for an echocardiogram after their admission
in a caldiology clinic of a tertiary center. Immediately before
echocardiography, the patient was examined by two independent clinicans, a
consultant cardiologist and one trainee, who had no information in terms of
history, ECG, chest x-ray or other medical data.Results: For the consultants,
the greatest sensitivity of cardiac auscultation was shown in aortic stenosis
(86,5%) and the lowest in the tricuspid regurgitation (36%) respectively. The
greatest specificity was shown in mitral stenosis (99,4%) and the lowest in
mitral regurgitation (88,7%), while the greatest positive prognostic value was
87,5% in mitral stenosis and the lowest (69,6%) in aortic stenosis
respectively. For the trainees, the sensitivity of the aortic stenosis was
found similar compared to consultants, but significantly lower (18%) for the
aortic regurgitation. The positive prognostic value was 100% for mitral
stenosis, while the negative prognostic value was 47,5% for the regurgitation
of the mitral valve. Also, the results were clinically sufficient for the
diagnosis of the significant valvulopathies (more than moderate
degree).Conclusions: The cardiac auscultation is undoubtedly one of the most
important initial diagnostic approaches helping to reveal heart diseases.
However, the skill of the physicians in cardiac auscultation is limited, due
to the fact, that even experienced cardiologists nowadays by pass meticulous
auscultation for a transthoracic echocardiogram to obtain their initial
clinical assessment. Moreover, what has to be emphasized is that clinical
examination should not be replaced by echocardiography. The last method should
be used only as an additional clinical tool especially in demanding cases where
there is uncertainty to determine the severity of heart disease.
Echocardiography, Auscultation, Heart, Assessment, Sound
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