Utility of physical examination and comparison to echocardiography for cardiac diagnosis.

Objective: To find out the accuracy of cardiac auscultation using non-digital stethoscope in physical diagnosis of cardiac diseases.

Methods: We enrolled 104 consecutive patients with abnormal cardiac auscultatory findings attending cardiology clinic and not previously evaluated by echocardiography. One time detailed cardiac physical examination followed by echocardiography within 1 month was undertaken. Agreement between two methods was calculated using mean pair percentage agreement, kappa statistics (κ) and calculation of 95% confidence interval (CI) for kappa statistics.

Results: Using kappa statistics, there was almost perfect agreement between cardiac auscultation and echocardiography for the detection of mitral stenosis (κ=0.865; CI 0.76-0.97) and ventricular septal defect (κ=0.872; CI=0.73-1.01). Substantial agreement was noted for aortic stenosis (κ=0.752; CI=0.56-0.94), pulmonary stenosis (κ=0.647; CI=0.33-0.97) and atrial septal defect (κ=0.646; CI=0.32-0.97), while moderate agreement was found for mitral regurgitation (κ=0.470; CI=0.30-0.64), aortic regurgitation (κ=0.456; CI=0.25-0.66) and tricuspid regurgitation (κ=0.575; CI=0.38-0.77). For combined mitral stenosis and mitral regurgitation lesions, almost perfect agreement was found for mitral stenosis (κ=0.842; CI=0.691-0.993) while fair agreement noted for mitral regurgitation (κ=0.255; CI=-0.008 to 0.518).

Conclusion: Careful clinical auscultation using a stethoscope remains a valuable tool for cardiac diagnosis. Decision on initial diagnosis and management of valvular and congenital heart diseases should be based on clinical examination and integrating such information with echocardiography as required.