suck at cardiac auscultation...how to suck less?

[mossyfiber12]

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I can't for the life of me seem to able to differentiate between murmurs. There were some sites listed on an old thread but many of those links have expired...

This is the only site I have come across that's somewhat helpful:

http://www.blaufuss.org/

 

[DrBowtie]

Just be able to tell if something doesn't sound normal at this stage in the game. They'll be getting an echo anyway to diagnose definitively.

 

[RySerr21]

Thats cuz its hard. Like the other said - just recognize not normal. I told my resident "hey his heart sounds weird, you should probably listen to it cuz I'm not even gonna guess what I think it is, I just know its not normal."

 

[Shinken]

I can't for the life of me seem to able to differentiate between murmurs. There were some sites listed on an old thread but many of those links have expired...

This is the only site I have come across that's somewhat helpful:

http://www.blaufuss.org/

The best way to get better at auscultation, in my opinion, is to do the following:

- Listen to different stethoscopes to see which one you like (I swear by the Welch-Allyn Elite. I've tried others, including Littman's and I'm definitely a W-A guy).

- Learn to differentiate between S1 and S2. If the rate is slow it's easy, if the rate is a little faster, try feeling the patient's pulse at the same time you auscultate to find S1 (S1 will precede the pulse, then S2, then S1 - pulse, then S2...)

- Once you can easily identify S1 from S2, learn the basic systolic and diastolic murmurs.

- Get a nice book with CD that explains the main murmurs (most medical libraries have these too, so you don't have to buy your own)

It's true that we will always obtain an echo anyway, but learning to auscultate and form a good differential will make you a better doctor, and your patients will appreciate you more (which leads to more referrals and business). I know it's hard now, but trust me, just like with anything in medicine, you will get this eventually if you work at it.

 

[mmmcdowe]

Do it, a lot. Round on your patients multiple times a day and listen to their hearts if you like.

 

[ArcGurren]

Honestly this is kinda tough... you just have to listen to a metric ton of hearts. Also a good steth helps, I had a piece of crap one that I couldn't hear anything with. After buying a better one I can hear a lot more clarity.

I picked up on a couple of murmurs in practice.

 

[OveractiveBrain]

I can't for the life of me seem to able to differentiate between murmurs. There were some sites listed on an old thread but many of those links have expired...

This is the only site I have come across that's somewhat helpful:

http://www.blaufuss.org/

http://www.cardiosource.org/certified-education/elearning-and-products/heart-songs-3.aspx

I got into this website when I was a medic (pre medschool), when they were free for anyone to download. They have been uber vamped and are now for sale. They are totally worth it.

Beyond listening to the bad sounds in Heart Songs, its listening to literally every patient, in all 4 cardiac auscultation spots, for 10-15 beats. It is the act of doing, of listening, over and over and over and over again.

I've got my residents (as a medical student) writing aortic stenosis over and over again...when it was mitral stenosis. Most people don't do it well, so if you find someone who does, stick to them like glue.

 

[OveractiveBrain]

Also a good steth helps, I had a piece of crap one that I couldn't hear anything with. After buying a better one I can hear a lot more clarity.

This is more true than most peopel would care to admit. People say its whats between the stethoscope that matters. Bogus. The better the stethoscope, the more certain you are that what you hear is what you hear. The more confidence you have in your scope, the less likely you are to blame anyone but yourself when you can't hear it. The better the scope, the more likely you are to hear lower grade murmurs.

I like to think its the farmer, not the tools, but sometimes, having a tractor is better than an Ox.

 

[strv04]

LOL here is all you need to know about asculation

if the murmur is really loud and systolic and there is no recent echo with an explanation get an echo
if the murmur is diastolic get an echo
if its quite and systolic meh ...

learn to report this in your notes

Normal rate, regular rythmn, no murmers rubs or gallops, good s1 and s2, no jvd, no extremity edema, pulse +2 x4

or shorthand

NR, RR, no m/r/g, good s1/s2 -edema, -jvd, pulses +2 x4

off course you should alter the above if there is something abnormal

 

[TheLesPaul]

This is more true than most peopel would care to admit. People say its whats between the stethoscope that matters. Bogus. The better the stethoscope, the more certain you are that what you hear is what you hear. The more confidence you have in your scope, the less likely you are to blame anyone but yourself when you can't hear it. The better the scope, the more likely you are to hear lower grade murmurs.

I like to think its the farmer, not the tools, but sometimes, having a tractor is better than an Ox.

Not quite bogus. Any of the standard Littman's will get you where you need to go. The most important thing I learned from my month on Cards is to anticipate the murmurs. If I knew that a patient had HTN and I expected to hear an opening click (however subtle), it made it much easier to hear. Going through the steps of classification (is this systolic/diastolic, is this getting louder or is it blowing, where is it loudest, etc) routinely also helps.

One thing I still have difficulty with is localizing the murmur -- these systolic flow murmurs can be louder at the upper or lower sternal border, and it's just difficult to pin them down!

 

[BobBarker]

Hear murmur. Check for old echo. No old echo, get one.

 

[Depakote]

When you're listening to heart sounds, start listening for S1 and S2. Concentrate on figuring out which is which. Once you have the lub-dub isolated... you'll usually notice if something is wrong, that tends to be the abnormal sound.

But try to find the normal first, then let the abnormal present itself.

 

[justaregularmed]

I think it would be expected for you to at least identify what the murmur is if its obvious, but not grade it or anything like that. Remember talking about the murmur (systolic v. diastolic, where is it loudest, clicking etc) is just as good as identifying it in some peoples books.

Don't get me wrong I think murmurs are as hard as the next guy but just give it some time and effort and you'll get it.

 

[SB100]

Close your eyes while doing it. Not only do I find I can listen slightly better, but it makes the patient think you know what you're doing 😛

Don't get too discouraged if you have a hard time. I picked up a murmur on a patient whose own PCP hasn't detected.

 

[officedepot]

1. feel the pulse at the same time you listen.

2. know what the diagnosis is before going in and then listen. That probably will work the best.

And you know regardless of what you hear if it is at all concerning you'll get an echo to evaluate further. Rarely will a big clinical decision be made on purely listening to the heart. Now a full cardiac exam is very helpful for certain things but imaging is usually done at some point in care.

 

[DD214_DOC]

Hear murmur. Check for old echo. No old echo, get one.

👍

If it's in an old person, probably a SEM 2/2 AS.

If it's in a young person, either a flow murmur or MVP.

Either way, who cares. Check for an old echo, get a new one if aforementioned old echo is nonexistant.

And I'm not sure about the above. I haven't used a stethoscope in a few months.