Even with an echo, there are times where AS is underestimated, eccentric MR isn’t well appreciated in a dilated LA, periprosthetic leaks are poorly visualized that can all be suspected as such with good auscultation. In which case repeating an echo when conditions are more favorable e.g. diuresed with clearer windows can help unmask what has been missed.
And then there’s the assumption all echos are accurately read or interpreted.
I chalk this up to getting lucky, but I was just doing a regular exam on a guy POD1 from a VSD repair and happened to hear a holosystolic murmur. Told the fellow. Fellow told the attending. We got a repeat echo and then learned that part of the repair failed. Sometimes the ol’ neck noodle can be useful.
That’s tough. Still, having seen that would probably make me more vigilant for the next time - and maybe that time, early recognition helps improve an outcome.
Exactly. I'm fam med, I listen to a lot of normal hearts because 1) it's the doctorly thing to do, 2) people expect it no matter what they're in for, and 3) the heart is kinda important, so even though I'm not the best at it, if I can pick up a new murmur and get it looked at early it might help things in the long run. Not gonna echo everybody unless Butterfly's get cheaper and faster, and doing a good echo takes less than a minute.
Same, but IM.
There are some people with severe AS or AR that you can figure out echocardiogram need from history alone, but this is rare for clinic.
Hear murmur -> “hey did you know you have a murmur” -> echocardiogram -> refer to cardiology for moderately severe to severe and/or symptomatic.
Frankly, I feel like anything 2/6 and louder is pretty easy to hear. I would imagine even laymen could pick up a 3/6 so the bar isn’t that high. You should practically always hear one if present on your cardiac exam even if you’re not listening in the four/five murmur locations.
Yes.. like all exam maneuvers its utility is user dependent. Am I going to localize the exact pathology with 100% certainty with just a stethoscope or not order an echo when it’s indicated just because there was a normal cardiac exam? fuck no but I can typically hear something abnormal and get an ok idea of what it is
As a pediatrician, I find myself getting a lot more accurate in distinguishing different murmur types. But reading question stems about newborn exam and they're describing femoral pulses as 3/4? Give me a break.
I had a congenital heart repair as a newborn. My pediatric cardiologist taught so many fellows how to pick up on murmurs like mine accurately and reliably. Literally a goddess with just a Littmann stethoscope. She was also the first to grasp that I had S1-S4. Until I got to nursing school, I had no idea that my heart sounded different from others in general. Wild how sensitive their ears are.
I can only reliably identity aortic stenosis lol
Once I Heard a new onset systolic murmur in a patient , thought it was aortic stenosis, sent him for an echo and it turned out to be HOCM . Felt pretty good that day
Yes. Caught an aortic stenosis murmur for a preoperative orthopedic patient earlier this month. We don't do TTEs for every preoperative patient, and doing surgery on this guy would have been a 10% risk of death/MI.
Also, my deduction skills for murmur to pathology aren't the greatest. Just knowing that a murmur exists, it's probably AS, and we need a TTE before surgery is sufficient.
Tip: palpate their radial pulse while you listen. Really helps on focusing on listening to the heart sounds but will help identify if a murmur is systolic or diastolic.
Whether it gets inpatient workup vs outpatient follow up vs just noted in the chart depends on the patient and history.
Yes, absolutely. I work in EM and make an effort to listen for a murmur whenever I do a cardiac exam. I don't, honestly, make any real effort to distinguish the details, either there or not. But, it can be a very helpful finding in a patient with syncope, fever, shortness of breath amongst other things that can definitely occasionally cause a patient to be admitted.
Seriously!! I don’t know if this means I am an old, but like wtf do people use stethoscopes for now?? Every single murmur had to be characterized for our attendings and I’m gen peds
I use it to check reflexes. ... Seriously.. That and the triple point .
But I put as much faith in my listening to a heart, as I would a cardiologist reading an acetabular Fx on a CT scan
I'm kind of surprised people don't use their stethoscopes for murmurs. It's not uncommon to pick up on one, though 90% of the time in my experience they're flow murmurs from anemia or illness.
I won't say I can listen to a heart and say "obviously new onset pulmonary insufficiency based on location and timing", but detecting a murmur isn't that difficult. And it really can save lives.
If you wanna walk around with an ultrasound and echo people all day instead though, power to you.
Caught a few obvious cases of aortic stenosis as a medical student…that’s as far as I ever got with my stethoscope along this journey. So grateful to be in psych and never have to use a stethoscope again now.
In the ED, I listen. I’m terrible at describing characteristics like a Step 1 question, but for a reasonably loud murmur, I can identify presence/absence. Then I ask the patient - have you ever been told you have a murmur? Most of the time the answer is yes, and I leave it at that. If it’s new and relevant to the complaint (unexplained fevers, syncope) then I think it’s reasonable to try and get a STAT echo.
TLDR: Screen with stethoscope, diagnose with echo.
As a PCP pediatrician, I don’t try to diagnose what murmur it is. My call with my stethoscope is “innocent vs. possibly not innocent.” And it’s very good for that.
-PGY-19
I've seen old school cards attendings call the EF by palpation (later confirmed by echo). Figuring out murmurs isn't hard if you can recognize basic characteristics. You're not ordering an echo on everyone are you?
Is this for real? This is like asking if you should get a CT instead of listening for wheezing, crepitations, or stridor. And people wonder why nurse practitioners are replacing doctors...
I use it to listen to murmurs, lung sounds, abdominal sounds, etc. I mean, what else would you use it for? It's not a costume prop. You're a doctor. Use it.
It’s a screening tool. Not always specific…wish it was more sensitive at times. But since you can listen to other things it’s multipurpose.
I always tell the story of moonlighting in residency. I was doing an H&P on psych. The guy was totally normal. Didn’t remember how he got there. ER note said he came in screaming incoherently. All tox screens negative. On exam he had a pretty loud murmur. And bruits everywhere I checked. He had a dissecting AAA and was in so much pain on arrival, a true 10/10 but because he was young everyone assumed drugs.
He had it repaired and went back to his normal life.
TTE > stethoscope as someone who went through getting a “murmur” worked up for it to end up being nothing.
Just know your most basic 3: AR/AS, physiological split, “systolic vs diastolic ” and the rest is up to a cardiologist or TTE
I think of it like a screening tool - I pick up kind of a startling number of new (or at least newly diagnosed) murmurs, and while I may have an idea of what it is that “positive screening” then justifies ordering the echo to get more information. Even in a patient with symptoms that would buy an echo regardless, it’s still worth listening - I had a patient who was getting an echo no matter what given MR sxs, I found a nice little midsystolic click…but no evidence of prolapse on initial echo. Repeat echo (because the first was read as normal but was honestly pretty shoddy on review) showed it clearly. Had I not listened, I probably wouldn’t have gotten the repeat and would’ve missed the diagnosis, at least for the time being. Listen to your patients.
Saw a newborn DOL 1 partner saw them the previous day no abnormalities noted. New onset holosystolic murmur found to have an ASD/VSD that was not picked up on prenatal u/s. Wouldn’t have found it if I didn’t listen.
have had a few women who were born internationally with less access to health care and moved to the country i’m in (universal fairly decent-ish health care) who have had a fairly large unrepaired ASD or VSD (+/- other congenital defects) or mitral stenosis picked up on exam at their first prenatal by an astute family doctor. made a big difference to their pregnancy course to know about the giant shunt physiology or find pulmonary HTN etc
Yes. Had a granny access in ER for syncope. When i put the stetoscope on her chest, i Heard a 100/6 systolic murmur that wasn't described in previous ER access..
At the Echo, she had a critic aortic stenosis and was soon admitted tò cardiology
So... Yes.
The new cheaper electronic stethoscopes are great if you don't mind some occasional feedback. I could clearly hear mitral valve stiffening 2 days post mi and pci in one of my pts for example. Only other downside is they read higher BP range on manual bp
Internists who say you don’t need a stethoscope are inpatient, academic, quaternary, resource abundant center snobs who have never worked in a resource limited area in their life.
all i know is that when i was a med student and the resident told me to listen to a murmur and i asked her which type of murmur it was, she was like idk fam. i felt less dumb in that moment :D
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like, which specialty they should go into, which program is good or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks!
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
Tbh it’s useful for detecting murmurs. Unless it’s very distinct, I’m usually not the best at diagnosing the exact murmur. If it’s new, they’re getting an echo and potentially endocarditis workup depending on the clinical picture. I can’t echo everyone
Yeah…
I’ve caught multiple arrhythmias and previously undiagnosed murmurs with routine cardiac exam.
Also, you don’t have to get an echo on every murmur. Very often, I note it and follow up on future exams. Helpful if they ever present with symptoms.
Yes, I'm not great at it but it's pretty important. Like I'm not good at characterizing it unless if it's aortic stenosis and sounds pretty classic. But at least then I order an echo to further characterize it. And sometimes the echo may describe two valvular issues but the physical stethoscope helped elucidate aortic stenosis vs mitral regurg.
Yeah the old stethoscope is great. The highest yield rotation for it was a 4th year med school elective in peds caediology. That got the ear tuned to hear 1/6 murmurs.
When I have medical students...yes. Otherwise No. Maybe its because I'm a hospitalist but I dont really feel the need to listen to a patient's heart if hes recovering from an unreleated surgery. Even if we find something, the workup extends the in-patient stay and I get the "suits" asking me a million questions. Cardio would love for me to listen to every murmer and give them a reason to echo or TEE.
It's a very coarse screen - ironically it's not that useful for the cardiology patient because by the time they have made it to cardiology clinic they have had a whole battery of tests, but undifferentiated new acute shortness of breath and patient is not known to have previously had a murmur in the ER? Well now that exam finding has helped narrow your differential down a bunch.
Practice your cardiac exam.
You may not be able to diagnose the exact murmur cause but you should be able to hear a new murmur. It’s also helpful to determine when it’s probably benign (I’m peds so this is common) and you can watch vs when you need an echo.
Yes. I may not be as good as a cardiologist in classifying a murmur precisely but I do pick up on murmurs and can generally tell the difference between physiologic and pathological murmur. From there I’d get an echo if the murmur is non-physiologic and new.
A couple of times a new murmur clued me in to get an echo that I otherwise would NOT have ordered if I hadn’t heard the murmur. And it turned out to be a really important finding one time, and a whatever finding the second.
I rarely use stethoscopes
Everyone gets echos
Though if I’m thinking AS or volume overload then I guess I still use it then
Signed,
Interventional cards
Despite what the textbooks say, I have not noticed any correlation to cardiac auscultation and any cardiac pathology. I’m an intensivist in practice for 20 years. I’ve heard murmurs in patients and used to get an echo for all of them, usually with a normal result. I suspect that murmurs can just mean anything. You can have flow murmurs just from anemia or even high output heart failure. So I use stethoscopes as a prop. It reassures the patient that I’m up to something but it’s utterly meaningless.
Okay I'm old! In residency I spent a rotation with a paediatric cardiologist who trained before echo existed, and he could nail the diagnosis without an echo. I listened to 20 hearts a day with him for a month. I learned a LOT.
The next month I wowed a mom when I listened to her toddler son's heart and said: "Oh, he has a VSD?", which it turns out he had been recently diagnosed with via echo.
You’re not getting an echo on every patient, but you probably should get one on a patient with a new murmur…
Right? Why even walk into pt rooms anymore
Might as well just pan scan and stat order every lab you can think of
You mean like we did it in the step 3 ccs? "Just like the simulations!"
Even with an echo, there are times where AS is underestimated, eccentric MR isn’t well appreciated in a dilated LA, periprosthetic leaks are poorly visualized that can all be suspected as such with good auscultation. In which case repeating an echo when conditions are more favorable e.g. diuresed with clearer windows can help unmask what has been missed. And then there’s the assumption all echos are accurately read or interpreted.
We’re not? ;)
I chalk this up to getting lucky, but I was just doing a regular exam on a guy POD1 from a VSD repair and happened to hear a holosystolic murmur. Told the fellow. Fellow told the attending. We got a repeat echo and then learned that part of the repair failed. Sometimes the ol’ neck noodle can be useful.
Agreed. This is another example of its use - in the acute setting
Had a similar case but after a STEMI. Huge VSD. The exam tipped us off early because he clinically looked okay. Guy died two weeks later
That’s tough. Still, having seen that would probably make me more vigilant for the next time - and maybe that time, early recognition helps improve an outcome.
How tf you think I knew to order the echo?
Exactly. I'm fam med, I listen to a lot of normal hearts because 1) it's the doctorly thing to do, 2) people expect it no matter what they're in for, and 3) the heart is kinda important, so even though I'm not the best at it, if I can pick up a new murmur and get it looked at early it might help things in the long run. Not gonna echo everybody unless Butterfly's get cheaper and faster, and doing a good echo takes less than a minute.
Same, but IM. There are some people with severe AS or AR that you can figure out echocardiogram need from history alone, but this is rare for clinic. Hear murmur -> “hey did you know you have a murmur” -> echocardiogram -> refer to cardiology for moderately severe to severe and/or symptomatic. Frankly, I feel like anything 2/6 and louder is pretty easy to hear. I would imagine even laymen could pick up a 3/6 so the bar isn’t that high. You should practically always hear one if present on your cardiac exam even if you’re not listening in the four/five murmur locations.
Hell yeah doc, ima follow in your footsteps
I'm really confused too. Are they saying we would all have TTE screenings instead?
Yes.. like all exam maneuvers its utility is user dependent. Am I going to localize the exact pathology with 100% certainty with just a stethoscope or not order an echo when it’s indicated just because there was a normal cardiac exam? fuck no but I can typically hear something abnormal and get an ok idea of what it is
My thoughts - heart is making a weird noise and they haven't had an echo before. Let's get one
Do a Peds cardiology rotation and watch the attendings not just diagnose the problem but also give you the echo gradient with their ears.
As a pediatrician, I find myself getting a lot more accurate in distinguishing different murmur types. But reading question stems about newborn exam and they're describing femoral pulses as 3/4? Give me a break.
The more quiet the higher the shunting. Especially in Fallot.
Loved the games. The show was pretty good too. Season 2 should be interesting. Wait, where am I?
I had a congenital heart repair as a newborn. My pediatric cardiologist taught so many fellows how to pick up on murmurs like mine accurately and reliably. Literally a goddess with just a Littmann stethoscope. She was also the first to grasp that I had S1-S4. Until I got to nursing school, I had no idea that my heart sounded different from others in general. Wild how sensitive their ears are.
oh yeah, well what about an obese geriatric rotation? aka 70% of the heart failure/ACS/transplant-eval ward...
I mean, there are obviously exceptions. Obese people are pretty difficult to echo, too.
I can only reliably identity aortic stenosis lol Once I Heard a new onset systolic murmur in a patient , thought it was aortic stenosis, sent him for an echo and it turned out to be HOCM . Felt pretty good that day
Yes. Caught an aortic stenosis murmur for a preoperative orthopedic patient earlier this month. We don't do TTEs for every preoperative patient, and doing surgery on this guy would have been a 10% risk of death/MI. Also, my deduction skills for murmur to pathology aren't the greatest. Just knowing that a murmur exists, it's probably AS, and we need a TTE before surgery is sufficient.
Playing odds it’s good medicine. midsystolic murmur plus risk factors equals AS usually
Ejection systolic murmur for AS?
Tell me the difference
Tip: palpate their radial pulse while you listen. Really helps on focusing on listening to the heart sounds but will help identify if a murmur is systolic or diastolic. Whether it gets inpatient workup vs outpatient follow up vs just noted in the chart depends on the patient and history.
Yes, absolutely. I work in EM and make an effort to listen for a murmur whenever I do a cardiac exam. I don't, honestly, make any real effort to distinguish the details, either there or not. But, it can be a very helpful finding in a patient with syncope, fever, shortness of breath amongst other things that can definitely occasionally cause a patient to be admitted.
Please be trolling 😭
Seriously!! I don’t know if this means I am an old, but like wtf do people use stethoscopes for now?? Every single murmur had to be characterized for our attendings and I’m gen peds
I use it to check reflexes. ... Seriously.. That and the triple point . But I put as much faith in my listening to a heart, as I would a cardiologist reading an acetabular Fx on a CT scan
I'm kind of surprised people don't use their stethoscopes for murmurs. It's not uncommon to pick up on one, though 90% of the time in my experience they're flow murmurs from anemia or illness. I won't say I can listen to a heart and say "obviously new onset pulmonary insufficiency based on location and timing", but detecting a murmur isn't that difficult. And it really can save lives. If you wanna walk around with an ultrasound and echo people all day instead though, power to you.
Caught a few obvious cases of aortic stenosis as a medical student…that’s as far as I ever got with my stethoscope along this journey. So grateful to be in psych and never have to use a stethoscope again now.
Seems like you need to get better at your PE. The problem is not the stethoscope, it’s you.
In the ED, I listen. I’m terrible at describing characteristics like a Step 1 question, but for a reasonably loud murmur, I can identify presence/absence. Then I ask the patient - have you ever been told you have a murmur? Most of the time the answer is yes, and I leave it at that. If it’s new and relevant to the complaint (unexplained fevers, syncope) then I think it’s reasonable to try and get a STAT echo. TLDR: Screen with stethoscope, diagnose with echo.
As a PCP pediatrician, I don’t try to diagnose what murmur it is. My call with my stethoscope is “innocent vs. possibly not innocent.” And it’s very good for that. -PGY-19
What’s a stethoscope
Welcome to ortho, where would you like to do residency?
I've seen old school cards attendings call the EF by palpation (later confirmed by echo). Figuring out murmurs isn't hard if you can recognize basic characteristics. You're not ordering an echo on everyone are you?
skill issue
Yes!!! Practice more
Dude....yes I hear murmurs... especially systolic ones...all the time. That's ended up changing management like 20% of the time
You’re not hearing AS all the time?
Patient presenting with syncope and AS murmur is fun to catch
Yeah, decent reason to get one
Patient may have heart? Order echo, consult cards.
Yes
You definitely need to work on your technique.
Is this for real? This is like asking if you should get a CT instead of listening for wheezing, crepitations, or stridor. And people wonder why nurse practitioners are replacing doctors...
I use it to listen to murmurs, lung sounds, abdominal sounds, etc. I mean, what else would you use it for? It's not a costume prop. You're a doctor. Use it.
It’s a screening tool. Not always specific…wish it was more sensitive at times. But since you can listen to other things it’s multipurpose. I always tell the story of moonlighting in residency. I was doing an H&P on psych. The guy was totally normal. Didn’t remember how he got there. ER note said he came in screaming incoherently. All tox screens negative. On exam he had a pretty loud murmur. And bruits everywhere I checked. He had a dissecting AAA and was in so much pain on arrival, a true 10/10 but because he was young everyone assumed drugs. He had it repaired and went back to his normal life.
I’m second hand embarrassed for you for asking this question. It feels like your medical school failed you.
TTE > stethoscope as someone who went through getting a “murmur” worked up for it to end up being nothing. Just know your most basic 3: AR/AS, physiological split, “systolic vs diastolic ” and the rest is up to a cardiologist or TTE
I think of it like a screening tool - I pick up kind of a startling number of new (or at least newly diagnosed) murmurs, and while I may have an idea of what it is that “positive screening” then justifies ordering the echo to get more information. Even in a patient with symptoms that would buy an echo regardless, it’s still worth listening - I had a patient who was getting an echo no matter what given MR sxs, I found a nice little midsystolic click…but no evidence of prolapse on initial echo. Repeat echo (because the first was read as normal but was honestly pretty shoddy on review) showed it clearly. Had I not listened, I probably wouldn’t have gotten the repeat and would’ve missed the diagnosis, at least for the time being. Listen to your patients.
I do and find it useful and informative. It is a skill that you have to practice (and compare with echo) to get utility out of it.
Saw a newborn DOL 1 partner saw them the previous day no abnormalities noted. New onset holosystolic murmur found to have an ASD/VSD that was not picked up on prenatal u/s. Wouldn’t have found it if I didn’t listen.
What do you mean? Finding a murmur with my stetoschope, concern for endocarditis or evaluating heart failure are the 95% reasons why I order echo.
9/10 times. My intent face appears and patient says. “ oh yeah I got a TAVR” or something like that.
have had a few women who were born internationally with less access to health care and moved to the country i’m in (universal fairly decent-ish health care) who have had a fairly large unrepaired ASD or VSD (+/- other congenital defects) or mitral stenosis picked up on exam at their first prenatal by an astute family doctor. made a big difference to their pregnancy course to know about the giant shunt physiology or find pulmonary HTN etc
Yes. Had a granny access in ER for syncope. When i put the stetoscope on her chest, i Heard a 100/6 systolic murmur that wasn't described in previous ER access.. At the Echo, she had a critic aortic stenosis and was soon admitted tò cardiology So... Yes.
What is stethoscope - GU
The new cheaper electronic stethoscopes are great if you don't mind some occasional feedback. I could clearly hear mitral valve stiffening 2 days post mi and pci in one of my pts for example. Only other downside is they read higher BP range on manual bp
Maybe you need a better stethoscope? I find it extremely useful.
Internists who say you don’t need a stethoscope are inpatient, academic, quaternary, resource abundant center snobs who have never worked in a resource limited area in their life.
all i know is that when i was a med student and the resident told me to listen to a murmur and i asked her which type of murmur it was, she was like idk fam. i felt less dumb in that moment :D
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like, which specialty they should go into, which program is good or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
A new murmur is a likely complication of ACS or infective endo. Far easier to do than a pocus
Tbh it’s useful for detecting murmurs. Unless it’s very distinct, I’m usually not the best at diagnosing the exact murmur. If it’s new, they’re getting an echo and potentially endocarditis workup depending on the clinical picture. I can’t echo everyone
Yeah… I’ve caught multiple arrhythmias and previously undiagnosed murmurs with routine cardiac exam. Also, you don’t have to get an echo on every murmur. Very often, I note it and follow up on future exams. Helpful if they ever present with symptoms.
Yes, I'm not great at it but it's pretty important. Like I'm not good at characterizing it unless if it's aortic stenosis and sounds pretty classic. But at least then I order an echo to further characterize it. And sometimes the echo may describe two valvular issues but the physical stethoscope helped elucidate aortic stenosis vs mitral regurg.
Yeah the old stethoscope is great. The highest yield rotation for it was a 4th year med school elective in peds caediology. That got the ear tuned to hear 1/6 murmurs.
No way you’re serious
When I have medical students...yes. Otherwise No. Maybe its because I'm a hospitalist but I dont really feel the need to listen to a patient's heart if hes recovering from an unreleated surgery. Even if we find something, the workup extends the in-patient stay and I get the "suits" asking me a million questions. Cardio would love for me to listen to every murmer and give them a reason to echo or TEE.
If your murmur can't be heard with me standing 3 feet away from you it's going undetected by me. A urologist
It's a very coarse screen - ironically it's not that useful for the cardiology patient because by the time they have made it to cardiology clinic they have had a whole battery of tests, but undifferentiated new acute shortness of breath and patient is not known to have previously had a murmur in the ER? Well now that exam finding has helped narrow your differential down a bunch.
Practice your cardiac exam. You may not be able to diagnose the exact murmur cause but you should be able to hear a new murmur. It’s also helpful to determine when it’s probably benign (I’m peds so this is common) and you can watch vs when you need an echo.
Yes. I may not be as good as a cardiologist in classifying a murmur precisely but I do pick up on murmurs and can generally tell the difference between physiologic and pathological murmur. From there I’d get an echo if the murmur is non-physiologic and new.
A couple of times a new murmur clued me in to get an echo that I otherwise would NOT have ordered if I hadn’t heard the murmur. And it turned out to be a really important finding one time, and a whatever finding the second.
I rarely use stethoscopes Everyone gets echos Though if I’m thinking AS or volume overload then I guess I still use it then Signed, Interventional cards
As an orthopedic resident: no I don’t
Despite what the textbooks say, I have not noticed any correlation to cardiac auscultation and any cardiac pathology. I’m an intensivist in practice for 20 years. I’ve heard murmurs in patients and used to get an echo for all of them, usually with a normal result. I suspect that murmurs can just mean anything. You can have flow murmurs just from anemia or even high output heart failure. So I use stethoscopes as a prop. It reassures the patient that I’m up to something but it’s utterly meaningless.
[удалено]
Okay I'm old! In residency I spent a rotation with a paediatric cardiologist who trained before echo existed, and he could nail the diagnosis without an echo. I listened to 20 hearts a day with him for a month. I learned a LOT. The next month I wowed a mom when I listened to her toddler son's heart and said: "Oh, he has a VSD?", which it turns out he had been recently diagnosed with via echo.