Handheld ultrasound: stetoscope retirement?

    Authors

    Keywords

    handheld ultrasound, stetoscope

    DOI

    https://doi.org/10.15836/ccar.2015.85

    Full Text

    Handheld ultrasound (HHU) machine is a pocked-sized, battery operated device limited to 2-dimensional and color Doppler imaging. HHU examination is becoming part od bedside diagnostic methods and in near future it will probably became an important part of medical education. Incorporation of HHU as an adjunct to the pxysical examination rouse speculation that auscultation will become less important. So report by Mehta et al confirmed the value of HHU in accuracy improvement of bedside cardiac diagnosis (1). They assume however that increase experience with HHU will decrease the use of stethoscope. In their response article Steinhubl and Topol, among others, advocate stethoscope retirement in favor of HHU (2). From practitioner view heart auscultation before any echo examination, either HHU or standard, further improves diagnostic accuracy. It provides better clinical perception, directs examination, and help us not to miss certain pathology. Good example is characteristic ASD auscultatory finding (pulmonic midsystolic ejection murmur and fixed splitting of the second heart sound) which warns on defect presence and in case of normal echo finding obligate us to proceed with transesophageal echocardiography (TEE). Another example is artificial valve malfunction where changes in the normal sounds produced by prosthetic valve help us to recognize the problem and regardless of HHO finding standard and TEE examination are indicated in each patient.

    Literature

    1. Mehta M, Jacobson T, Peters D, Le E, Chadderdon C, Allen AJ, et al. Handheld ultrasound versus physical examination in patients referred for transthoracic echocardiography for a suspected cardiac condition. JACC Cardiovasc Imaging. 2014;7:983–90. https://doi.org/10.1016/j.jcmg.2014.05.011
    2. Steinhubl SR, Topol EJ. RESPONSE: time for the pager to enter retirement. J Am Cardiol. 2014;64(24):2705.
    Cardiologia Croatica
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    Handheld ultrasound: stetoscope retirement?

    Abstract
    Issue3-4
    Published
    Pages85
    PDF via DOIhttps://doi.org/10.15836/ccar.2015.85
    handheld ultrasound
    stetoscope

    Authors

    Niksa Drinkovic*ORCIDPolyclinic Professor Niksa Drinkovic, Zagreb, Croatia
    Niksa Drinkovic*ORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: kardiologija@poliklinika-niksa-drinkovic.hr

    Full Text

    Handheld ultrasound (HHU) machine is a pocked-sized, battery operated device limited to 2-dimensional and color Doppler imaging. HHU examination is becoming part od bedside diagnostic methods and in near future it will probably became an important part of medical education. Incorporation of HHU as an adjunct to the pxysical examination rouse speculation that auscultation will become less important.

    So report by Mehta et al confirmed the value of HHU in accuracy improvement of bedside cardiac diagnosis (1). They assume however that increase experience with HHU will decrease the use of stethoscope. In their response article Steinhubl and Topol, among others, advocate stethoscope retirement in favor of HHU (2). From practitioner view heart auscultation before any echo examination, either HHU or standard, further improves diagnostic accuracy. It provides better clinical perception, directs examination, and help us not to miss certain pathology. Good example is characteristic ASD auscultatory finding (pulmonic midsystolic ejection murmur and fixed splitting of the second heart sound) which warns on defect presence and in case of normal echo finding obligate us to proceed with transesophageal echocardiography (TEE). Another example is artificial valve malfunction where changes in the normal sounds produced by prosthetic valve help us to recognize the problem and regardless of HHO finding standard and TEE examination are indicated in each patient.

    Literature

    1. 1.
      Mehta M, Jacobson T, Peters D, Le E, Chadderdon C, Allen AJ, et al. Handheld ultrasound versus physical examination in patients referred for transthoracic echocardiography for a suspected cardiac condition. JACC Cardiovasc Imaging. 2014;7:983–90.DOI
    2. 2.
      Steinhubl SR, Topol EJ. RESPONSE: time for the pager to enter retirement. J Am Cardiol. 2014;64(24):2705.