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The Physiologic Origins of Heart Sounds and Murmurs.

John Michael Criley. CMEA, Inc, 1436 W. Randolph, Chicago, IL 60607. (800) 227-CMEA.

PRICE: $150 plus shipping and handling. Optional Stethoscope Sounder: $40.


HARDWARE & SOFTWARE REQUIREMENTS: PC with 486SX processor, 8MB RAM, 2X CD-ROM drive, 256-color SVGA monitor at 640 x 480 pixels, Windows 3.1 or later, Windows-compatible sound card (16-bit recommended), mouse, keyboard, and external speakers, headphones, or stethoscope. A level II multimedia PC is recommended. Macintosh LC III or better with System 7 or later, 8MB RAM, 2X CD-ROM drive, 256-color monitor at 640 x 480 pixels, mouse, keyboard, and external speakers, headphones, or stethoscope.

CUSTOMER SUPPORT: CMEA toll-free phone number.

GUARANTEE: 30-day return policy.


Heart Sounds and Murmurs claims to be the first and only complete multimedia CD-ROM to integrate actual heart sounds with dynamic images. It features 200 heart sounds with graphic images, chest x-rays, arterial and venous pulses, pathology slides, and more.

Heart Sounds comes with no written installation instructions. There is a readme.exe file that provides a 1-screen introduction to the program's straightforward interface. There is also an install.exe file that puts less than 1 MB of information on the user's hard drive. Once the program is loaded, users are shown a title screen with 4 options: General Tutorials, Timing of Heart Sounds, Timing of Murmurs, and Catalog of Lesions. Each choice leads to another screen of options. For example, after choosing Timing of Heart Sounds, the user is given 6 new options (such as Opening Sounds, Third Sounds, Fourth Sounds). As shown in the Figure, Third Sounds presents 6 more options. For the Mitral Regurgitation selection, the diagram on the upper left of the screen can be toggled among cineangiography of the left ventricle, a diagrammatic representation of the structures seen on the cine, and cine with overlying animation of the blood flow (illustrated), all in sync with the audible heart-sound recordings. Simultaneously, the yellow heart sound line on the top right of the figure progressively turns from gray to yellow as each new sound occurs. Thus, the user can simultaneously see the murmur in a cineangiogram (with animated overlays if desired), see an animated depiction of each sound as it is occurring, and listen to the murmur through headphones, computer speaker, computer speaker and stethoscope, or Stethoscope Sounder and the stethoscope.


Sound quality was acceptable with a laptop's built-in speakers (with or without a stethoscope) and with external speakers. With the stethoscope, there was a noticeable hum from the computer components. Potential purchasers should listen to their speakers with their stethoscopes (with the speakers on, but not playing any sound) to decide whether the noise level justifies purchasing the Stethoscope Sounder, which eliminates the computer-generated noise.

For a few cardiac findings, Heart Sounds permitted electronic elimination of one sound to allow concentration on other sounds. There should be options for users to start with the first and second heart sounds and add and subtract other sounds or to vary the heart rate continuously over a wide range. Such builds would significantly enhance the teaching value and clinical utility of the software. There is no feature that allows the user to retrace steps or select and sequence items to create a lecture or slide show. Also, there was no ability to cut and paste text materials to produce handouts, and no feature for quizzing on unknowns from the CD's contents.

Practices involved in teaching medical students and residents, as well as family practice residency libraries, should consider Heart Sounds as a teaching tool, if they can afford it. It is a rare physician who already knows everything in Heart Sounds, so even experienced clinicians will find some material of value. However, for those reasonably comfortable with the basics of what they need to know, this program is probably not worth the expense. As an alternative, there are Web sites that have heart and lung sounds available for downloading; however; they supply only a few sounds and do not have simultaneous visual depiction. On cursory review, sounds downloaded from some of these sites had more background noise than those in Heart Sounds.
Gary N. Fox, MD
Toledo, Ohio
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Article Details
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Title Annotation:Review
Author:Fox, Gary N.
Publication:Journal of Family Practice
Date:Apr 1, 1999
Previous Article:Evidence-Based Family Medicine.
Next Article:Get This. (Art In Medicine).

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