Advanced Physical Diagnosis
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• 1st & 2nd Heart Sounds
• 2nd & 3rd Heart Sounds
• Clicks and Snaps
• Murmurs
• Rubs
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  • Patient HX
  • Physical Exam
  • Laboratory & Imaging
Differential Dx
Evidence Base
• Accuracy in Diagnosis of Systolic Murmurs
• Accuracy in Diagnosis of Diastolic Murmurs
• Accuracy in Diagnosis of CHF
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[Skill Modules >> Heart Sounds & Murmurs >> History ]

History: Heart Sounds & Murmurs

Even before the invention of auscultation and percussion, physicians were able to detect abnormalities in a patient's heart by palpation and by assessing the pulse. For example, the connection between atrial fibrillation and mitral valve disease was first made in the 1700s by Jean Baptiste de Senac (1693-1770), physician to King Louis XV of France and author of the first text on cardiology (McMichael).

In 1816 Laennec created a paper acoustic device as a stethoscope in order to examine the chest of a woman with cardiac symptoms. He listened to her heart by the technique he called "mediate auscultation". Laennec described his creation of the stethoscope instrument in The Treatise on Mediated Auscultation in 1821:

"I was consulted in 1816 by a young woman who presented some general symptoms of disease of the heart, in whose case the application of the hand and percussion gave but slight indications, on account of her corpulency. On account of the age and sex of the patient, the common modes of exploration being inapplicable, I was led to recollect a well known acoustic phenomenon, namely if the ear is applied to one extremity of a beam, a person can, very distinctly, hear the scratching of a pin at the other end. I imagined this property of bodies might be made use of in the present case. I took a quire of paper which I rolled together as closely as possible, and applied one end to the precordial region; by placing my ear at the other end, I was agreeably surprised at hearing the pulsation of the heart much more clearly and distinctly that I had ever been able to do by the immediate application of the ear."

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