Dr. Melissa Kwan

Dr. Melissa Kwan, a pediatric emergency physician, listens as Dr. Reid Thompson, a pediatric cardiologist at Johns Hopkins Childrens Center, teaches a workshop for physicians about using stethoscopes to detect heart problems. She is using stethophone, which is equipped with recorded sounds from real cardiac patients with various conditions. (Barbara Haddock Taylor, Baltimore Sun / February 14, 2012)

Some murmurs sounded like blowing or clicking, and some were louder or faster.

Their diagnosis in patients could mean the difference between assurance that a murmur is "innocent" or indicates a dire condition such as hypertrophic cardiomyopathy, or thickened heart muscle, known for causing sudden cardiac death in young athletes.

Thompson worked with a former medical student to develop a website, called the murmurlab, accessible to any doctor or student who wants it. And he worked with Hopkins' Applied Physics Laboratory to design technology to capture sounds and images. The lab also helped create an algorithm that someday Thompson expects to automatically interpret murmurs, perhaps in rural areas or places where there aren't doctors trained in auscultation. (Thompson has a financial stake in a company developing that technology.)

Thompson said better training in auscultation should mean fewer referrals of patients with innocent mumurs to cardiologists and fewer echocardiograms that can cost up to $900 each.

"However, when we do see patients with only an innocent mumur, we can clear the air and be reassuring for the parents and the referring doctor just by confirming that no further testing is needed."

Thompson said he plans to continue teaching students and doctors at Hopkins, and even in the community.

One student who plans to use it is Sandesh Rao, a third-year Hopkins medical student who recently completed a workshop on auscultation with Dr. Bob Dudas, an associate director of medical education in the school of medicine.

"This is just scratching the surface," Rao said of the workshop. But, he said, "Eventually, I'll be a more confident and better diagnostician."

Some of the doctors trained with mumurlab say they may now think twice about a referral to cardiology for images, or more likely, they will be "smarter in communicating" what may be wrong, said Dr. C. Jean Ogborn from Hopkins' emergency department.

But after an auscultation lesson where several physicians didn't agree on diagnoses, Dr. Amy Polonsky, said she recognizes the work ahead.

"I'm a pianist and guitarist, and heart sounds have always been almost musical to me," she said. "But this is a tough skill. I think everyone hears them a little differently."


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