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Journal of veterinary internal medicine2002; 15(6); 507-515; doi: 10.1892/0891-6640(2001)0152.3.co;2

An assessment of the ability of diplomates, practitioners, and students to describe and interpret recordings of heart murmurs and arrhythmia.

Abstract: The ability of clinicians, ie, 10 veterinary students, 10 general practitioners, and 10 board certified internists, to describe and interpret common normal and abnormal heart sounds was assessed. Recordings of heart sounds from 7 horses with a variety of normal and abnormal rhythms, heart sounds, and murmurs were analyzed by digital sonography. The perception of the presence or absence of the heart sounds S1, S2, and S4 was similar for clinicians irrespective of their level of training and was in agreement with the sonographic interpretation on 89, 82, and 78% of occasions, respectively. However, practitioners were less likely to correctly describe the presence of S3. The heart rhythm was correctly described as being regular or irregular on 89% of occasions, and this outcome was not affected by level of training. Differentiation of the type of irregularity was less reliable. The perception of the intensity of a heart murmur was accurate and correlated with the grade assigned in the living horses, R2 = .68, and with sonographic measurements of the murmur's intensity, R2 = .69. Clinicians overestimated the duration of cardiac murmurs, particularly that of the loud systolic murmur. Only diplomates could reliably differentiate systolic from diastolic murmurs. The ability to diagnose the underlying cardiac problem was significantly affected by training; diplomates, practitioners, and undergraduates made the correct diagnosis on 53, 33, and 29% of occasions, respectively. The poor diagnostic ability of practitioners and the lack of improvement in diagnostic skill after the 2nd year of veterinary school emphasizes the need for better teaching of these skills. Digital sonograms that combine sound files with synchronous visual interpretations may be useful in this regard.
Publication Date: 2002-01-31 PubMed ID: 11817055DOI: 10.1892/0891-6640(2001)0152.3.co;2Google Scholar: Lookup
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  • Journal Article
  • Research Support
  • Non-U.S. Gov't

Summary

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The research study aimed to analyze the ability of different vet practitioners and students to correctly identify and interpret various normal and abnormal heart sounds in horses. Various heart sound recordings from seven horses were used for the assessment and the participants included 10 students, 10 practitioners, and 10 specialized internists. The results showed that certification and training greatly influenced their diagnostic abilities, and highlighted a need for better teaching tools such as digital sonograms.

Participants and Methodology

  • The research included 30 participants divided into three groups: 10 veterinary students, 10 general practitioner veterinaries, and 10 board certified internist veterinaries.
  • A total of seven horses with a variety of heart conditions were part of this study. Digital recordings of their heart sounds with various normal and abnormal rhythms, sounds, and murmurs, were used for the assessment.

Findings

  • There was a notable consistency among the clinicians concerning the perception of presence or absence of the heart sounds S1, S2, and S4. This was irrespective of their level of training, agreeing with sonographic interpretations on an average of about 83% of the times.
  • General practitioners were less successful in describing the presence of the S3 heart sound correctly compared to other participants.
  • Overall, the ability to identify the rhythm of the heart as being regular or irregular was high across all participating groups. However, identifying the type of irregularity in rhythm was less successful.
  • The assessment of the intensity of a heart murmur was also found to be accurate, having a good correlation with the live grading of the murmur’s intensity and sonographic measurements.
  • However, the participants tended to overestimate the duration of the cardiac murmurs. The differentiation between systolic and diastolic murmurs was only accurately made by board-certified internists.
  • The ability to diagnose underlying cardiac problems was found to be significantly influenced by training and specialization, with board certified internists making correct diagnoses more often than practitioners and students.

Conclusion and Future Implications

  • The results of this study underline the dire need for better training and teaching techniques for diagnosing heart sounds, particularly for general practitioners and training veterinarians.
  • It emphasized the fact that the proficiency in diagnosing heart conditions does not improve significantly after the second year of veterinary school.
  • The research also suggested that the use of digital sonograms, offering combined sound files with concurrent visual interpretations, could be a useful tool to improve diagnostic skill sets.

Cite This Article

APA
Naylor JM, Yadernuk LM, Pharr JW, Ashburner JS. (2002). An assessment of the ability of diplomates, practitioners, and students to describe and interpret recordings of heart murmurs and arrhythmia. J Vet Intern Med, 15(6), 507-515. https://doi.org/10.1892/0891-6640(2001)0152.3.co;2

Publication

ISSN: 0891-6640
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 15
Issue: 6
Pages: 507-515

Researcher Affiliations

Naylor, J M
  • Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada. jon.naylor@usask.ca
Yadernuk, L M
    Pharr, J W
      Ashburner, J S

        MeSH Terms

        • Adult
        • Animals
        • Arrhythmias, Cardiac / diagnosis
        • Arrhythmias, Cardiac / veterinary
        • Diagnosis, Differential
        • Education, Veterinary
        • Heart Auscultation / standards
        • Heart Auscultation / veterinary
        • Heart Murmurs / diagnosis
        • Heart Murmurs / veterinary
        • Horse Diseases / diagnosis
        • Horses
        • Humans
        • Middle Aged
        • Observer Variation
        • Professional Competence
        • Veterinary Medicine / standards

        Citations

        This article has been cited 6 times.
        1. van Staveren MDB, Muis E, Szatmári V. Self-Reported Management of Incidentally Detected Heart Murmurs in Puppies: A Survey among Veterinarians. Animals (Basel) 2024 Jun 19;14(12).
          doi: 10.3390/ani14121821pubmed: 38929440google scholar: lookup
        2. Hövener J, Pokar J, Merle R, Gehlen H. Association between Cardiac Auscultation and Echocardiographic Findings in Warmblood Horses. Animals (Basel) 2021 Dec 5;11(12).
          doi: 10.3390/ani11123463pubmed: 34944240google scholar: lookup
        3. Nath LC, Elliott AD, Weir J, Curl P, Rosanowski SM, Franklin S. Incidence, recurrence, and outcome of postrace atrial fibrillation in Thoroughbred horses. J Vet Intern Med 2021 Mar;35(2):1111-1120.
          doi: 10.1111/jvim.16063pubmed: 33604980google scholar: lookup
        4. van Staveren MDB, Szatmári V. Detecting and recording cardiac murmurs in clinically healthy puppies in first opinion veterinary practice at the first health check. Acta Vet Scand 2020 Jun 25;62(1):37.
          doi: 10.1186/s13028-020-00535-1pubmed: 32586343google scholar: lookup
        5. Marinus SM, van Engelen H, Szatmári V. N-Terminal Pro-B-Type Natriuretic Peptide and Phonocardiography in Differentiating Innocent Cardiac Murmurs from Congenital Cardiac Anomalies in Asymptomatic Puppies. J Vet Intern Med 2017 May;31(3):661-667.
          doi: 10.1111/jvim.14667pubmed: 28316101google scholar: lookup
        6. Szatmári V, van Leeuwen MW, Teske E. Innocent Cardiac Murmur in Puppies: Prevalence, Correlation with Hematocrit, and Auscultation Characteristics. J Vet Intern Med 2015 Nov-Dec;29(6):1524-8.
          doi: 10.1111/jvim.13632pubmed: 26415555google scholar: lookup