The first 200 years of cardiac auscultation and future perspectives

Abstract

Cardiac auscultation - even with its limitations - is still a valid and economical technique for the diagnosis of cardiovascular diseases, and despite the growing demand for sophisticated imaging techniques, clinical use of the stethoscope in medical practice has not yet been abandoned. In 1816, René-Théophile-Hyacinthe Laënnec invented the stethoscope, while examining a young woman with suspected heart disease, giving rise to mediated auscultation. He described in detail several heart and lung sounds, correlating them with postmortem pathology. Even today, a correct interpretation of heart sounds, integrated with the clinical history and physical examination, allows to detect properly most of the structural heart abnormalities or to evaluate them in a differential diagnosis. However, the lack of organic teaching of auscultation and its inadequate practice have a negative impact on the clinical competence of physicians in training, also reflecting a diminished academic interest in physical semiotic. Medical simulation could be an effective instructional tool in teaching and deepening auscultation. Handheld ultrasound devices could be used for screening or for integrating and improving auscultatory abilities of physicians; the electronic stethoscope, with its new digital capabilities, will help to achieve a correct diagnosis. The availability of innovative representations of the sounds with phono- and spectrograms provides an important aid in diagnosis, in teaching practice and pedagogy. Technological innovations, despite their undoubted value, must complement and not supplant a complete physical examination; clinical auscultation remains an important and cost-effective screening method for the physicians in cardiorespiratory diagnosis. Cardiac auscultation has a future, and the stethoscope has not yet become a medical heirloom.

Keywords: auscultation; cardiac physical examination; medical history; medical sciences; stethoscope.

Figure 1

Laënnec’s masterpiece, entitled De l’auscultation médiate ou Traité du Diagnostic des Maladies des Poumonet du Coeur [A treatise on the diseases of the chest and on mediate auscultation], 1819. Notes: Image from Bibliothèque Nationale de France. Image courtesy of the Bibliothèque Nationale de France. Reproduced from Laënnec RTH. De l’auscultation médiate ou Traité du Diagnostic des Maladies des Poumons et du Coeur [A treatise on the diseases of the chest and on mediate auscultation]. Paris: Chaude; 1819. French.

Figure 2

Laënnec at the bedside performing direct auscultation. Notes: Image from the U.S. National Library of Medicine. Painting by Théobald Chartran (1849–1907).