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Computer-Aided Auscultation of the Heart: The Clinical Opportunity
White Paper Introduction
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Clinicians have long depended on the stethoscope
as the clinical tool that helps them to characterize
heart sounds and identify abnormalities suggestive
of underlying cardiac disease. However, as technology
advances, the confidence of most physicians in their
ability to accurately detect abnormal cardiac findings
through physical examination is diminishing.
Advanced technologies have become so much the
standard in the practice of cardiology that physicians
have abandoned basic clinical assessment techniques
and are unable to appreciate the cardiac findings
that may be obtained with the stethoscope.
Before the technological revolution, the well-trained
physician was capable of diagnosing cardiac disease
consistently and accurately using basic clinical skills
with the assistance of the stethoscope. Despite the
current emphasis on technology in medicine, it still
holds true that most patients seen in clinical practice
today for evaluation of cardiovascular disease can be
accurately diagnosed in the physician’s office
through careful cardiac clinical examination.
Precise auscultation of the heart with a stethoscope
throughout the cardiac cycle provides the clinician
with information on the timing, duration, pitch,
location, and intensity of normal heart sounds
(S1 and S2) and can reveal the presence or absence
of other sounds, such as S3, S4, and murmurs.
However, auscultation performed with a stethoscope
is inherently difficult in that it is based on the
examiner’s ability to hear and interpret a wide variety
of sounds, most of which fall within the lower
ranges of sounds detectable by the human auditory
system. Furthermore, the practice is highly subjective,
with descriptions of auscultatory sounds varying
greatly among clinicians. In the current era of
advanced technology, cost containment, and managed
care, there is a great need to renew the clinical
skill of cardiac auscultation and bring it back to the
forefront of cardiac care and diagnosis. Today, the
clinical skills of the well-trained physician who can
make an accurate and cost-effective cardiovascular
diagnosis in the office or at the bedside are becoming
increasingly important. A cost-effective device that
would improve the clinical skills of cardiac auscultation
and provide physicians with additional information as
to whether they should refer patients for more
expensive and sometimes invasive procedures
is warranted.
A computer-aided auscultation device would be
expected to improve the diagnostic accuracy of this
fundamental practice by reinforcing good auscultatory
practices and providing objective, repeatable findings
that are readily interpretable. The purpose of
this monograph is to describe the potential role
of computer-aided auscultation devices in clinical
practice.
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