Background Clinical assessment of diastolic heart sounds is challenging. Hypothesis We sought to examine whether visual inspection of acoustic cardiographic tracings augments the accuracy of medical students' and physicians' detection of third and fourth heart sounds (S3, S4) compared to auscultation alone. Methods A total of 90 adults referred for left heart catheterization underwent digital precordial heart sound recordings by computerized acoustic cardiography. Two blinded, experienced readers using a consensus method determined the presence of the S3/S4 on each file. There were 35 subjects from the following 5 groups participating in this study from 1 teaching institution: first-year medical students (n = 5), fourth-year medical students (n = 5), interns (n = 5), medicine residents (n = 5), cardiology fellows (n = 5), and attendings (n = 10). Using a computer module, each subject listened to the heart sounds alone and documented whether an S3/S4 was present. Next, subjects listened to each recording in random order while viewing phonocardiographic tracings, and recorded S3/S4 presence. Results An S3 was present in 21 patients (23%) and an S4 in 31 patients (34%) by consensus overread in 90 recordings. Baseline accuracy for auscultation of S3/S4 did not change with level of experience. While viewing the acoustic cardiogram, first-year medical students had minimal improvement in S3 (2%) and S4 (11%) accuracy. More experienced subjects improved S3 accuracy by 8% to 18% and S4 by 15% to 32% ( P .05). Accuracy was superior for S3 compared to S4 in all ausculatory groups. Conclusions While listening to heart sound recordings, viewing acoustic cardiography increased subjects' accuracy in detecting diastolic heart sounds, particularly among more experienced subjects. There was greater improvement for S4 compared to S3 detection. Copyright ? 2009 Wiley Periodicals, Inc.
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