An assessment of the ability of diplomates, practitioners, and students todescribe and interpret recordings of heart murmurs and arrhythmia

The ability of clinicians, ie, 10 veterinary students, 10 general practitio ners, and 10 board certified internists, to describe and interpret common n ormal and abnormal heart sounds was assessed. Recordings of heart sounds fr om 7 horses with a variety of normal and abnormal rhythms, heart sounds, an d murmurs were analyzed by digital sonography. The perception of the presen ce or absence of the heart sounds S1, S2, and S4 was similar for clinicians irrespective of their level of training and was in agreement with the sono graphic interpretation on 89, 82, and 78% of occasions, respectively. Howev er, practitioners were less likely to correctly describe the presence of S3 . The heart rhythm was correctly described as being regular or irregular on 89% of occasions, and this outcome was not affected by level of training. Differentiation of the type of irregularity was less reliable. The percepti on of the intensity of a heart murmur was accurate and correlated with the grade assigned in the living horses, R-2 =.68, and with sonographic measure ments of the murmur's intensity, R-2 = .69. Clinicians overestimated the du ration of cardiac murmurs, particularly that of the loud systolic murmur. O nly diplomates could reliably differentiate systolic from diastolic murmurs . The ability to diagnose the underlying cardiac problem was significantly affected by training; diplomates, practitioners, and undergraduates made th e correct diagnosis on 53, 33, and 29% of occasions, respectively. The poor diagnostic ability of practitioners and the lack of improvement in diagnos tic skill after the 2nd year of veterinary school emphasizes the need for b etter teaching of these skills. Digital sonograms that combine sound files with synchronous visual interpretations may be useful in this regard.