Effect of Obesity on the Ability of Physicians to hear Heart Murmurs

Objective: There is a lack of heart auscultation studies in obese patients. Our aim was to evaluate the effects of obesity on the ability of physicians to hear heart murmurs. Methods: 30 patients with body mass index (BMI)>30 kg/m2 were auscultated by a cardiologist and a resident using electronic and acoustic stethoscopes. 15 patients were auscultated by one cardiologist and one resident and 15 patients-by another cardiologist and another resident using both stethoscopes for each auscultation. Auscultation data was verified by an echocardiogram: auscultation sensitivity and specificity was calculated. Echoscopic subcutaneous adipose tissue (SCAT) measurements at the listening site and body shape were included in the analysis. Results: There does not appear to be a predictive relationship between BMI and SCAT. Although most of the patients had a rounded shape, it is not obvious that shape and BMI, when used together, allow one to predict SCAT. 85% of SCAT values were between 0.7 and 1.3. Sensitivity varied by stethoscope (p-value<0.0001), valve (p-value<0.0001), SCAT (p-value=0.0019). Specificity varied by valve (p-value=0.015). Conclusions: There is an indication that auscultation sensitivity varies with SCAT. It is a hypothesis for later confirmation because there was a limited range of SCAT values.