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

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.