Cardiopulmonary auscultation: duo for strings--Opus 99

Arch Intern Med. 1999 Nov 8;159(20):2477-9. doi: 10.1001/archinte.159.20.2477.


In spite of increasing mechanization in medicine and reliance on "high-tech" diagnostic tools, bedside clinical skills of the attending physician can still identify findings that are missed by the more sophisticated devices. Using a stethoscope, we relied on our skills in inspection, palpation, percussion, auscultation, as well as echocardiography and phonocardiography to diagnose a patient whose murmur was very reminiscent of the D-sharp pizzicato in the Cello Sonata in F, Opus 99, by Johannes Brahms. Initial echocardiography was not helpful. We suspected an anomalous chorda and confirmed this with phonocardiography and a second echocardiography. Although advances in cardiac imaging are extremely helpful, the use of simple clinical skills, in addition to being fun, is not obsolete. Cardiopulmonary auscultation should receive more emphasis in the medical school curriculum and clinical training.

Publication types

  • Case Reports

MeSH terms

  • Autopsy
  • Cardiomyopathy, Dilated / complications
  • Cardiomyopathy, Dilated / diagnosis
  • Chordae Tendineae / abnormalities*
  • Clinical Competence*
  • Diagnosis, Differential
  • Echocardiography
  • Fatal Outcome
  • Fibroma / complications
  • Fibroma / diagnosis
  • Heart Auscultation*
  • Heart Diseases / complications*
  • Heart Diseases / diagnosis*
  • Heart Murmurs / etiology*
  • Heart Neoplasms / complications
  • Heart Neoplasms / diagnosis
  • Heart Valve Diseases / complications
  • Heart Valve Diseases / diagnosis
  • Humans
  • Male
  • Middle Aged
  • Phonocardiography