Cardiologists: stethoscope advice?

Discussion in 'Cardiology' started by sdude, Apr 20, 2004.

  1. sdude

    sdude Member
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    Hello,

    I don't plan to become a cardiologist, but I like the field and I am really enjoying learning to auscultate. I definitely want to maximize my skills in this area, and am trying to choose a high-end stethoscope. I'd be grateful for some answers to a few questions:

    Is there any accoustical advantage to tunable-diapraghm designs? My basic Littmann uses this design, but I'm not sure I like it.

    So far I'm most attracted to traditional rotating bell-diapraghm designs with interchageable bells. Do these work well?

    Right now I'm leaning towards the Harvey DLX--any opinions on this stethoscope?

    Has anyone used a HP or Phillips Rappaport? I think those look awesome and I love the interchangeable parts, but is the design obsolete?

    Any other suggestions are welcome.

    Thanks,

    Dave
     
  2. SoCalDreamin'

    SoCalDreamin' Member
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    Go with the Littman Master Cardiology stethoscope. It is the best one out there in my opinion. It is my 2nd stethoscope.

    My first stethoscope was a Harvey DLX, and I could not stand using it, as it was aweful. The difference was night and day when upgrading to the Littman.
     
  3. sdude

    sdude Member
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    Okay. I've learned that everyone seems to hate the Welch-Allyn--so it's out.

    I'm looking seriously at the Littmann Master Cardiology (also heard very good things about the III).

    Has anyone has used the DRG cardiology scopes? I've heard very good things about their acoustics, but haven't ever been able to try one out.

    Thanks!
     
  4. jakstat33

    jakstat33 Senior Member
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    i have used both the littman cardiology and the harvey and must say that the harvey makes things much easier. things sound clearer and louder with the harvey-- very important when listening for subtle murmurs. most docs & students i have run into also prefer the harvey over the littman. also, get the one with the shortest tube!
     
  5. luckystar

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    I've got the DRG Staff Cardiology. It has the tunable diaphragm like the Littman Master Cardio, but it also has a separate bell, for the really low pitched sounds. It was recommended to me by a physician, but everybody's got their own preference, and you will learn to hear what you need to hear on whichever model you get.
     
  6. flighterdoc

    flighterdoc Rocket Scientist
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    I got a Master-II, (seemed like too much of a wanker to get a Master-III) and it's disappointing. I can hear better with a $10 nurses 'scope.
     
  7. sdude

    sdude Member
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    It's good to hear that I probably can't go too wrong. I'm kind of inclined towards the DRG or Harvey simply because everyone has a Littmann (including me--just a Select, though--good, but somewhat muffled acoustics for serious heart auscultation), and I'd like to try something different.
     
  8. sdude

    sdude Member
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    Anyone ever use a Hewlett Packard or Phillips Sprague-Rappaport? I think those are the gnarliest looking 'scopes. I don't know if the design is acoustically obsolete, though.

    It's funny that a "real" Rappaport is one of the most expensive stethoscopes, yet everyone and their dog makes copies for $15. Strange.
     
  9. luckystar

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    I don't have personal experience with these, but I have read that because the two tubes are out dangling around and rubbing against each other, it can add to the background noise that you have to filter. Sounds like a reasonable claim, unless you plan on using it only in very calm situations :)

    Oh, and a part of me went for the DRG because it was "different" ;)
     
  10. SoCalDreamin'

    SoCalDreamin' Member
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    Here is a good site for looking at stethoscopes:

    http://www.allheart.com/littmannstethoscopes.html

    Keep in mind that not all Littman's are created equal. The Master Cardiology series is the top of the line Littman model and is much better than some of the other Littman scopes. There is a product comparison chart on the website above. Simply click on the Littman scopes picture and then click on the product comparison link.

    I will reiterate to stay away from the Harvery DLX. Many of my classmates, including myself, purchased a Harvey DLX, and the majority of us didn't / don't like it.

    Remember though that when it comes to auscultation, it's what goes in between the earpieces that matters most. :D
     
  11. powermd

    Physician Lifetime Donor Classifieds Approved 15+ Year Member

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    As a med student it may make more sense to have a stethescope like the Littman Cardiology III, with adult and pediatric size diaphragms. The diaphragm of a Master Cardiology is as big as some pedi hearts! Most students I know have used the Cardiology III without complaints. I've tried the Master Cardiology and can't say I noticed much difference. The only stethescope I noticed a significant improvement with was a Welch-Allyn electronic model. I would worry less about which stethescope to buy, and more about learning to use it. In the end, if you become a cardiologist, purchasing a more expensive adult-only stethescope won't be a problem.
     
  12. Neuron

    Neuron Aequanimitas.
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    Awhile back there was a discussion on scopes on (of all places) the surgery forum. Some of the posts were quite detailed. Check it out:

    http://forums.studentdoctor.net/showthread.php?t=54138

    I have to disagree with the posters here who claim the Littman's are the best. This sort of thing is always a matter of opinion, but I think the worst scope ever (value-wise) is the Litt III. There is absolutely no benefit over the Litt II but it costs so much more. I thought the Harvey was a very good scope - very clear transmission. I have no opinion of the Litt master Cardiology series because I've never used one for extended periods of time, but the little experience I have with it has not convinced me of any benefit over the other Littmans.

    A Litt II is really all you need. If you want to get an expensive cardiology level scope, it's probably best to talk to someone (cardiologist) who has an interest in clinical diagnosis. Personally I'd recommend a Litt II + reading Sapira cover to cover. That last bit of advice, and practicing systematic auscultation on every single patient you see will likely be far, far more important than the brand of your stethoscope.
     
  13. madcadaver

    madcadaver Senior Member
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    I have a Philips Rappaport-Sprague, to replace a Littman Cardio III. I like the Philips better, partially because just about everyone at my institution is running around with Cardio III and I got tired of them. I think the Philips sonds better too, and it comes with interchangeable pedi diapraghm/bell.

    I got it for $75, new and sealed, on EBay.
     
  14. madcadaver

    madcadaver Senior Member
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    Oh, and don't forget, it won't matter what scope you're using if you're trying to auscultate through clothes.
     
  15. Neuron

    Neuron Aequanimitas.
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    Since you plunked down $75 for the "original" Rappaport Sprague, mind telling us if you've ever noticed a difference compared to the 10 buck Nurses' "Sprague"? I've always wanted to know, but haven't met anyone with the original.

    My guess is that there's no difference. The reason "everyone and their dog" has made a "Sprague" scope is, I think, that HP didn't properly patent it (or maybe the patent ran out or something, it's a very old scope).
     
  16. sdude

    sdude Member
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    That's an incredible deal. The cheapest I have seen them go for is $140. I would grab one for looks alone for that price.
     
  17. sdude

    sdude Member
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    Yeah, the patent definitely expired long ago, I think.

    I'd like to do a comparison, too, but I think the Phillips would probably win. It's hard to imagine that the materials and quality control on small but important issues like hose fit to the chestpiece, chestpiece locking mechanism, and biaurnal weight and shape could be equal on both scopes.
     
  18. madcadaver

    madcadaver Senior Member
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    The seller on ebay was "sharonscollectibles", check them out and maybe they still have em. Good scope for the money for sure.
     
  19. madcadaver

    madcadaver Senior Member
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    Sorry, I have no idea how it compares to nurses' stethoscopes. However, it is quite comparable in acoustic quality to the Littmans discussed above, and I prefer the look and the fit.
     
  20. BassDominator

    BassDominator Senior Member
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    I own a Cardiology III and a IIse. I started with the III because it's what everyone bought for physical diagnosis class. I then bought the IIse because it's lighter and fits better in my pocket. The accoustics are about the same. Although, my novice ears find the IIse a little louder with less background noice. Maybe it's me or I have a bum scope, but I thought the III was supposed to have better accoustics?
     
  21. ak1978

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    as a cardiologist once told me, "what's between your ears is more important than what's in your ears"

    i also highly recommend the cd rom "The physiologic origin of heart sounds and murmurs." (and lots of active practice--you can't be a passive listener when you auscultate).
     
  22. dbiddy808

    dbiddy808 Senior Member
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    I got the Master Cardiology one and I had heard that the short one is the best for hearing heart sounds so I got that one.

    Not a good idea.

    When you have to be all up close to patients with severe pneumonia the last thing you want to be doing is breathing in their germs.

    Regardless of what kind you get I suggest that you get a long one.
     
  23. jrmm

    jrmm Junior Member
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    I own a Littmann-Cardiology III and the accoustics are good. I highly recommend it.
    :thumbup:
     
  24. Tenesma

    Tenesma Senior Member
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    what is the point of a special stethoscope....????

    use one of those cheap ones they have in the MRSA/VRE rooms...

    1) if lung sounds/clinical situation warrants it: CXR
    2) if heart sounds/clinical situation warrants it: ECHO

    otherwise, use your brain.... the stethoscope, my friends has died....

    and nothing beats the feeling of spending 100 bucks, just to have it swiped by some nursing assistant or forgotten on some ER desk...
     
  25. ak1978

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    the stethoscope hasn't died--just auscultation skills. Studies show that cardiac auscultation is surprisingly sensitive/specific in experienced hands. I think many students fall into a viscious cycle where they don't bother learning how to properly auscultate because they are bad at it and don't have many good role models around to show that it can be learned; this further stagnates their skills and makes them more jaded.
     
  26. jdaasbo

    jdaasbo Senior Member
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    littman's are very poor stethoscopes i find. They have the best marketing to medical students, and look cool hanging around your neck. The problem with them i find is that the diaphragms are too loose and they have no bell. The cardio III allows you to remove the small diaphragm and turn it into a bell (and this is the only difference bet the no longer made cardio II and III). The problem is it sounds very very muffled. The master cardiology is the best one they make, i find, but it still suffers from a lack of a bell and a loose diaphragm. They market their scopes as having a "tunable" diaphragm, but in truth when you apply more pressure to any stethoscope's diagphram, you attenuate the low frequency sounds, leaving the higher ones. In addition you cannot rotate the ear pieces on a littman and thus if your external auditory canals dont line up with the littman earpieces, you are SOL.

    DRG's are ok, but they have longer tubes, which gives you poorer sound quality. I think that their non-vibrating tube is a nice feature.

    The Harvey stethoscope (not the Harvey Elite, but rather the Harvey DLX or the old style Harvey which you can still find) I think is the best. It was developed by the famous cardiologist Proctor Harvey the "godfather" of auscultation. The original has three heads, but it also comes as a two headed model. The third head is a corrugated diaphragm which serves to amplify heart tones (at the cost of very high and low frequency sounds). The bell is the best that there is. It is small and gives very very low sounds, perfect for faint S4 or S3 tones. The diaphgrams are very tightly bound to the chest piece and give very crisp tones. The chest piece is made of brass and is heavy but balanced. The weight gives you less vibration from your hand and allows you to rest the chest piece on the patients chest and remove your hand from it. The Harvey Elite is Welch Allyn's response to the littman cardio III and is made of stainless steel. It should cost about $150.

    the Phillips (hewlett Packard) Sprague-Rappaport is an excellent stethoscope. Like the Harvey, the diagphram is very tight. The bell is not as good as the Harvey's I find.

    As far as stethoscopes and auscultation being obsolete, i completely disagree. There is not faster cheaper way of quickly assessing patients, especially when and where echocardiograms are not available. Dont forget that the echo is also a very subjective test (the skill of the echo tech and the reader are HIGHLY variable.) Using the stethoscope takes time and patience. ultimately, the real instruments are your brain and ears, and that is why you see some cardiologists who are excellent at auscultation (and not all are!) using 50 dollar single tube littmans and such.

    So that's my three cents worth.
     
  27. ethat001

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    I'm a cardiology fellow and going to buy a stethoscopes in the next month or two. The post from jdasbo was pretty informative, although it was from three years ago. Any further updates on stethoscopes?
     
  28. Blue Dog

    Blue Dog Fides et ratio.
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    This thread addresses just about all of your questions to some degree.
     
  29. scuba5794

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