Book/Software Review - JAMPHL
Volume 1 Number 2, Spring 2003

Book/Software Review

Books and CD’s for Learning to Interpret Stethographics Waveforms


      The combination of the new Cardionics E-Scope II electronic stethoscope (http://www.cardionics.com) with the new PDA-compatable Stethographics visual display software (http://www.stethographics.com) has been an exciting new technological development for medical professionals with hearing loss. Learning to interpret the Stethographics visual display of heart and lung sounds takes time and patience. Several books and CD’s are available to facilitate interpretation of the waveforms (lung waveforms are called time amplitude plots of lung sounds, and heart waveforms are called phonocardiograms):

CD’s:

    1) Learning Cardiac Auscultation, Cardionics catalog #717-9147, c2001, Cardionics, Inc. Available from Cardionics for $89.00 for AMPHL subscribers, $99.00 for non-AMPHL subscribers.

    Description: This CD plays sounds and shows phonocardiograms for: normal heart sounds, physiological splitting of S2, paradoxical splitting of S2, third heart sound, fourth heart sound, summation sound, congestive heart failure, ejection sounds, atrial fibrillation, aortic regurgitation, valvular aortic stenosis, aortic stenosis and regurgitation, hypertrophic cardiomyopathy, mitral regurgitation, mitral stenosis, mitral stenosis and regurgitation, mitral valve prolapse, tricuspid regurgitation, atrial septal defect, ventricular septal defect, patent ductus arteriosus, pulmonary hypertension, congenital aortic stenosis, and innocent systolic murmurs. There are controls that allow you to add or remove murmurs or increase/decrease the volume of any sound component. There is a complete text explanation for all of the different heart sounds and murmurs.

    2) Learning Lung Sounds, Cardionics catalog #717-9148, c2002, Stethographics, Inc. Available from Cardionics for $49.00 for AMPHL subscribers, $59.00 for non-AMPHL subscribers.

    Description: This CD plays sounds and shows waveforms (time amplitude plots) of lung sounds for the following: bronchial sounds, vesicular sounds, fine and course crackles, wheezes, squawks, rhonchi, pleural rub, and stridor. Each sound is accompanied by a text explanation of what they sound like, what causes the sounds, and where they can be ausculted. Sounds and waveforms are also shown for normal patients and those with asthma, COPD, heart failure, pneumonia, bronchiectasis, and interstitial fibrosis. Seven clinical cases (human) are presented at the end of the CD as a practice test/self-assessment.

    3) A Simplified Introduction to Heart and Lung Sounds, c2002, Stethographics, Inc. Available from Stethographics for free with the purchase of the Stethographics visual display software, for $59.00 for AMPHL subscribers/non-AMPHL subscribers who did not purchase the Stethographics software.

    Description: This CD has two learning sections, the first section is Learning Lung Sounds, which is the same as #2 above, and the second section is Introduction to Heart Sounds. The Introduction to Heart Sounds section is divided into five parts: Introduction, Aortic Area, Pulmonic Area, Tricuspid Area, and Mitral Area. The introduction is mostly text with illustrations and briefly covers heart anatomy, human auscultatory sites, basic heart sounds, murmurs, and murmur mechanisms. For each section of the heart, sounds are played, phonocardiograms are shown, and text explanations are given for the different murmurs. The Aortic Area murmurs are: aortic stenosis, aortic sclerosis, patent ductus arteriosus, LV outflow tract obstruction, aortic insufficiency, and prosthetic aortic. The Pulmonic Area murmurs are: pulmonic stenosis, atrial septal defect, and pulmonic regurgitation. The Tricuspid Area murmurs are: tricuspid stenosis, tricuspid regurgitation, and ventricular septal defect. The Mitral Area murmurs are: mitral stenosis and mitral regurgitation.
Books:

    1) Fuster, Valentin, et al, eds. Hurst’s The Heart. 10th edition. New York: McGraw-Hill, 2001, pp 235-273. Available through http://www.amazon.com for $95.00.

    Description: This text has approximately 40 pages devoted to the physiologic and pathologic explanation of the four heart sounds, systolic ejection sounds, nonejection sounds, opening snaps, prosthetic valve sounds, extracardiac sounds, and heart murmurs. Illustrations include some phonocardiograms, but phonocardiograms are not shown for all of the sounds and murmurs described.

    2) Kvart, C and Häggström, J. Cardiac Auscultation and Phonocardiography in Dogs, Horses, and Cats. Sweden:TK i Uppsala AB, 2002. Available through VIN Bookstore (http://store.vin.com/vin) for $76.50.

    Description: This text has approximately 120 pages that explain the different heart sounds, arrythmias, and murmurs (in dogs, cats, and horses) complete with phonocardiograms and drawings of the heart to illustrate the physiology behind the heart sounds. This text also comes with a CD that plays all the different heart sounds illustrated in the book, it plays like a music soundtrack without any words or illustrations to go with it. The contents of this book and an example of the layout of this book can be found at http://www.cardiacauscultation.com.
CD and Book Review:

          For those working in the human medical field, I recommend both the Stethographics CD, A Simplified Introduction to Heart and Lung Sounds and the Cardionics CD Learning Cardiac Auscultation. The Stethographics CD A Simplified Introduction to Heart and Lung Sounds has an excellent coverage of both heart and lung sounds and the associated waveforms. I also believe the waveforms on this CD look more like the waveforms you will actually see on the Stethographics visual display software, as compared to the waveforms on the Cardionics CD Learning Cardiac Auscultation. The Cardonics CD Learning Cardiac Auscultation complements the Stethographics CD A Simplified Introduction to Heart and Lung Sounds very nicely in that it has some sounds not presented on the Stethographics A Simplified Introduction to Heart and Lung Sounds CD. I also like the feature on the Cardionics Learning Cardiac Auscultation CD that allows you to turn certain parts of the heart sounds off, or decrease/increase the volume of them in order to hear other sounds more clearly. This feature may facilitate training the ears of someone with a hearing loss to recognize different sounds, one at a time, before putting it all together. I do not recommend the sections in Hurst’s The Heart for your average medical professional. It is a highly technical description of all the heart sounds and murmurs that are guaranteed to be a night-time sleep aid. You would have to be extremely interested in cardiology to want to spend the amount of time required to understand what is presented in that text.

          For those in the veterinary medical profession, I highly recommend the Cardiac Auscultation and Phonocardiography in Dogs, Horses, and Cats. This is an excellent, easy to read textbook with great phonocardiogram illustrations. I would also get the Stethographics A Simplified Introduction to Heart and Lung Sounds CD to complement the information presented in this book and to give you the basics for the time amplitude plots of the lung sounds. To date, no one that I know of has tried to record time amplitude plots of lung sounds in animals, so extrapolation from humans and a lot of patience is going to be required.

          Please note that there may be other CD’s and books available to facilitate learning to interpret Stethographics waveforms. These are just the ones that I have found to date.
Reviewed by Candace C. Barrere, D.V.M.

Copyright © 2002 Association of Medical Professionals with Hearing Losses. All Rights Reserved.