Many critical acoustic aspects of cardiac auscultation cannot be adequately portrayed by phonocardiograms. To achieve greater scientific precision in auditory auscultation, clinicians must improve the way they listen to and describe cardiac noises. Acoustic phenomena can be directly communicated by tactile simulation with a stethoscope, or by the vocal use of onomatopoeic syllables. A proper description of the phenomena requires a "dissection" of: acoustic gestalts into the sonority, chronometry, and anatomy of what is heard. Included in the "dissection" is a consideration of the accentuations of cadence, the "masking" produced by synecphonesis, and the effects of hydraulic distortion. As an auscultator, the clinician is superior to the graphic machine because he can perceive acoustic as well as visual patterns; he can anticipate and recognize distortions; and he can clarify certain problems by the ad hoc use of positional maneuvers.
Feinstein AR. Acoustic Distinctions in Cardiac Auscultation: With Emphasis on Cardiophonetics, Synecphonesis, the Analysis of Cadence, and the Problems of Hydraulic Distortion. Arch Intern Med. 1968;121(3):209–224. doi:10.1001/archinte.1968.03640030001001
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