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    Computer-assisted auscultation improves

    Two years ago I wrote about digital stethoscopes and how my 3M Littmann 3200 stethoscope enables the recording and interpretation of heart murmurs by a computer program. The computer software, called Cardioscan, developed by Zargis Medical and distributed by 3M Littmann, indicates whether a suspicious murmur should be referred for a follow-up echocardiogram and cardiology consult.

    This year, Diacoustic Medical Devices, a South African company, has released its own software for murmur interpretation called SensiCardiac that works in conjunction with an electronic stethoscope from Thinklabs Medical called the ds32a+. The stethoscope features an electromagnetic diaphragm that converts body sounds to electronic signals immediately, before there is degradation of the transmitted sounds.

    The stethoscope also includes sophisticated ambient noise rejection, which can be turned on or off depending on the listening environment. Buttons on the control interface let users toggle between bell and diaphragm mode, adjust volume, mute all sounds, and switch between regular acoustic mode and an amplification mode that can enhance sound 50-fold. The stethoscope includes cables to transfer auscultated sounds to a computer or mobile device.

    The SensiCardiac software directs the user to input patient data, and the software listens at 4 locations on the chest corresponding to the areas of auscultation associated with the aortic, pulmonary, mitral, and tricuspid valves. One minute later, the software indicates whether the murmur is normal (innocent) or pathologic. Pathologic murmurs need further evaluation by a pediatric cardiologist.

    The software was developed to aide pediatricians in identifying murmurs in need of evaluation—these are class 1 murmurs as characterized by the American Heart Association and the American College of Cardiologists. This is particularly important because up to 80% of children have heart murmurs, but only 10% of children referred to pediatric cardiologists have pathologic cardiac disease.3 The software can be used in young infants because it works with heart rates up to 180 beats per minute.

    A recent study showed that SensiCardiac software correctly identified structural heart disease in a pediatric population with a specificity of 94% and sensitivity of 91%.4

    Now that all newborns are screened for critical congenital heart disease before discharge from the hospital, it is possible that the SensiCardiac software will eventually prove useful in further investigating the newborns that fail the screen or those babies who are noted to have a loud murmur in the nursery.

    The software sells for $350, and the Thinklabs Medical electronic stethoscope sells for $220. They can be purchased together for $550 from Diacoustic Medical Devices directly.

    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...


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