Abstract
The practice of cardiac auscultation is a critical tool used by physicians to detect alterations in the cardiovascular system. A case of both left and right sided endocarditis initially detected by electronic auscultation in a woman with a history of injection drug use is described. The electronic stethoscope, with the ability to amplify heart sounds, established the presence of both a systolic and diastolic murmur when standard auscultation failed to detect the diastolic component. Urgent standard echocardiography confirmed concurrent tricuspid and aortic valves endocarditis, and the patient was referred for surgical evaluation urgently. The present case demonstrates the value of the electronic stethoscope to amplify murmurs in the early detection of endocarditis. The case presented also serves as a useful reminder that right-sided endocarditis can have important leftsided complications.
Highlights
[1] Previous studies have suggested that the electronic stethoscope is significantly better in detecting low frequency sounds, is safe to be used in telemedical referral of patients with heart murmurs and has its place in everyday bedside practice [2] [3]
In a review of the literature, the presence of an early diastolic murmur was the most useful finding for establishing the presence of aortic regurgitation and its absence the most useful finding for eliminating the presence of aortic regurgitation [4]
Low-intensity, high-pitched aortic regurgitation murmurs may not be heard unless firm pressure is applied with the diaphragm of the stethoscope over the left sternal border or over the right second interspace, while the patient sits and leans forward with the breath held in full expiration [4]
Summary
Most patients with significant valvular heart disease are first diagnosed based on the finding of a murmur [1] Previous studies have suggested that the electronic stethoscope is significantly better in detecting low frequency sounds, is safe to be used in telemedical referral of patients with heart murmurs and has its place in everyday bedside practice [2] [3]. A comparison of the electronic stethoscope and the conventional auscultation has not been reported in the context of infective endocarditis
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