I was reading with interest the article of Lewis et al about the use of a new gadget for the detection of atrial fibrillation in general practice.1 The diagnosis of atrial fibrillation is very important, but do we need to invest in further instruments to screen for atrial fibrillation?
I think a cardiac auscultation should be part of a consultation, especially in the high older risk group. I diagnosed people in their 50s with atrial fibrillation who consulted me for their phimosis or for losing weight. Initially amused about the cardiac auscultation they were very thankful when I explained that their heart rhythm, if not treated, could cause serious problems in the future, for example, stroke.
Despite having had several consultations as a patient with several GPs in my life, no one checked my blood pressure or did auscultate my heart as yet (despite me being in my 50s). We have to come back to the physical examination that is more cost-effective and a quick screening tool when it is combined with prior adequate training and clinical reasoning. Not only are rhythm disturbances important, but structural heart disease can be asymptomatic, for example, in aortic regurgitation, despite being a serious cardiac abnormality.
Normal physical examination can exclude valvular regurgitation in asymptomatic patients, and no echocardiogram is necessary. If GP colleagues feel rusty regarding cardiac auscultation there are very good websites available to update oneself with murmurs and rhythms, or one could sit in with a cardiology colleague. One good heart sound tutorial, that is available free on the internet is ‘Blaufuss Multimedia – Heart Sounds and Cardiac Arrhythmias’.2
I hope that we are all listening to the patient more. This is not meant only for the soul, but applies to the body as well.
- © British Journal of General Practice, April 2011
