A paper containing a series of vignettes about the importance of cardiac auscultation recently appeared in the Cleveland Clinic Journal of Medicine (2012;79:536-44). The authors correctly point out that cardiac auscultation can provide useful and at times pivotal information that influences decision-making beyond echocardiography. For example, they describe a case of a patient referred for re-operation after surgery for aortic dissection who had severe aortic insufficiency noted on an echocardiogram; a physical exam and careful auscultation raised questions about the severity of the leak. A repeat echocardiogram failed to demonstrate more than mild-to-moderate AI and surgery was deferred.
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It is worthwhile to read papers like this one from time to time, and to recognize that our old physical examination skills do matter. As any cardiology fellow who has trained with me over the last 20 years can attest, I cherish my old HP stethoscope, and I value auscultation. A lot.
I’ll conclude with my own vignette, a story about aortic stenosis and Valentin Fuster. I was a fellow at the Cardiovascular Medicine Division at Mount Sinai Hospital; we overlapped for 1 year. During that time, I heard him tell a medical student, at the bedside of a patient with severe aortic stenosis: "You just listened to the murmur of aortic stenosis. At lunch time, you must come back to this bedside and listen to the murmur of aortic stenosis. And before you go home tonight, you must come here again and listen to the murmur of aortic stenosis. My friend, then you can go home and know that today, you listened to three murmurs of aortic stenosis!"
There is wisdom in that story. Auscultation rules.
Dr. Hauptman is professor of internal medicine and assistant dean of clinical-translational research at Saint Louis University and director of heart failure at Saint Louis University Hospital, and a member of the Cardiology News Editorial Advisory Board.