Auscultation of the Heart I

Abstract

"And the babe leaps up on his mother's arm I hear, I hear, with joy I hear."    Wordsworth.

All students find initial difficulty with auscultation and to some, variations in heart sounds and murmurs remain a mystery. However, given normal hearing, a good stethoscope, an appreciation of underlying mechanisms and reasonable opportunity to practise, everyone would become sufficiently competent. The essential requirements are a methodical approach and attention to detail and then, if what is heard is accurately recorded, the correct diagnosis should follow in most cases. It is important to be able to recognise variations in the intensity and splitting of the heart sounds, the physiological and pathological forms of triple rhythm and the murmurs associated with valvular stenosis or incompetence and with congenital cardiac and vascular defects. Recognition of auscultatory phenomena is important not only for accurate diagnosis but to avoid errors of interpretation and, in particular, the frequent error of suspecting or actually diagnosing heart disease when none is present and thereby engendering anxiety and imposing unwarranted restrictions.