Auscultatory Changes Identified through Digital Stethoscope and Echocardiographic Findings Associated with Healthy Pregnancy

Marilene Miranda Araújo, Zilma Silveira Nogueira Reis, Renata Baracho Porto, Cláudia Maria Villas Freire, Vitória Brito Goulart, Fabyulla A. Fernandes, Rosa Celeste Oliveira, Ricardo Cruz-Correia


The hyperkinetic hemodynamic pattern and the low viscosity of the blood are typical during pregnancy and cause a number of auscultatory changes. The main goal of this study was to describe hemodynamic and auscultatory changes in normal pregnant women and compare them to those of non-pregnant women. Digital heart auscultation and Doppler echocardiography tests were performed in 29 pregnant and 27 non-pregnant women, both healthy. Changes in the digital stethoscope auscultation and Doppler echocardiographic findings were compared between the groups. The low-intensity systolic murmur was statistically more frequent in the pregnant group (69.0% x 40.7%, p=0.034), as well as B1 Hyperphonesis (51.7% x 7.4%, p<0.001), B2 Hyperphonesis (69% x 18.5%, p<0.001) and B1 Split (89.7% x 29.6%, p<0.001). In pregnant women, no associations were found between auscultation findings and Doppler echocardiogram changes (mitral-murmur x mitral-regurgitation, p=0.675; tricuspid-murmur x tricuspid-regurgitation, p=1.000; pulmonary-murmur x pulmonary-regurgitation, p=1.000). The digital heart auscultation of healthy pregnant subjects was able to detect frequent and numerous alterations, confirming the importance of knowing the physiological changes of pregnancy. The normal Doppler echocardiogram in all healthy pregnant women with heart murmur indicates that such test has limited applicability for healthy pregnant subjects, only in cases of suspicion of a heart disease or when it does occur.


  1. Bloch, A. C., J..; Jaussi, A. 2001. Should Functional Cardiac Murmurs Be Diagnosed By Auscultation Or By Doppler Echocardiography Clin. Cardiol., 24, 767-769.
  2. Campos, O. A. J. L., ; Bocanegraa J.: Ambroseb, Antonio C. Carvalhoa, Keiko Harada” And Eulogio E. Martinez 1993. Physiologic Multivalvular Regurgitation During Pregnancy : A Longitudinal Doppler Echocardiographic Study. International Journal Of Cardiology, 80, 236-272.
  3. Cantwell R, C.-B. T., Cooper G, Dawson A, Drife J, Garrod D, Harper A, Hulbert D, Lucas S, Mcclure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O'herlihy C, Oates M, Shakespeare J, De Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A. 2011. Saving Mothers' Lives.Reviewing Maternal Deaths To Make Motherhood Safer: 2006-2008. Bjog, 118, 1- 203.
  4. Cardoso, C. M. G., A. M. M.; Ávila, W. S. 2012. Cardiopatia E Gravidez, São Paulo, Editora Atheneu.
  5. Chapman, A. B., Abraham, W. T., Zamudio, S., Coffin, C., Merouani, A., Young, D., Johnson, A., Osorio, F., Goldberg, C., Moore, L. G., Dahms, T. & Schrier, R. W. 1998. Temporal Relationships Between Hormonal And Hemodynamic Changes In Early Human Pregnancy. Kidney Int, 54, 2056-63.
  6. Chizner, M. A. 2002. The Diagnosis Of Heart Disease By Clinical Assessment Alone. Dis Mon, 48, 7-98.
  7. Chizner, M. A. 2008. Cardiac Auscultation: Rediscovering The Lost Art. Curr Probl Cardiol, 33, 326-408.
  8. Dahl, L. B., Hasvold, P., Arild, E. & Hasvold, T. 2002. Heart Murmurs Recorded By A Sensor Based Electronic Stethoscope And E-Mailed For Remote Assessment. Arch Dis Child, 87, 297-301; Discussion 297-301.
  9. Fujitani, S. & Baldisseri, M. R. 2005. Hemodynamic Assessment In A Pregnant And Peripartum Patient. Crit Care Med, 33, S354-61.
  10. Hanifin, C. 2010. Cardiac Auscultation 101: A Basic Science Approach To Heart Murmurs. Jaapa, 23, 44- 8.
  11. Hedayioglu, F. L., Mattos, S. S., Moser, L. & De Lima, M. E. 2007. Development Of A Tele-Stethoscope And Its Application In Pediatric Cardiology. Indian J Exp Biol, 45, 86-92.
  12. Huisman, C. M., Zwart, J. J., Roos-Hesselink, J. W., Duvekot, J. J. & Van Roosmalen, J. 2013. Incidence And Predictors Of Maternal Cardiovascular Mortality And Severe Morbidity In The Netherlands: A Prospective Cohort Study. Plos One, 8, E56494.
  13. Kaaja, R. J. & Greer, I. A. 2005. Manifestations Of Chronic Disease During Pregnancy. Jama, 294, 2751- 7.
  14. Kindig, J. R. B., T. P.; Campbell, R. W.; Andries, F.; Tavel, M. E. 1982. Acoustical Performance Of The Stethoscope: A Comparative Analysis. Am Heart J, 104, 269-75.
  15. Kindig, J. R. B., T. P.; Campbell, R.W.; Andries, F. And Tavel, M.E. & 1982. Acoustical Performance Of The Stethoscope- A Comparative Analysis American Heart Journal, 104, 269-275.
  16. Mangione S, N. L. 1997. Cardiac Auscultatory Skills Of Internal Medicine And Family Practice Trainees. A Comparison Of Diagnostic Proficiency. Jama, 278, 717-722.
  17. Mishra, M. C., J. B. And Jacckson, G. 1992. Murmurs In Pregnancy: An Auditof Echocardiography. Bmj, 304, 1413-1414.
  18. Pazin-Filho A , S. A., Maciel Bc 2004. Ausculta Cardíaca: Bases Fisiológicas - Fisiopatol. Medicina, Ribeirão Preto, 37, 208-226.
  19. Pereira, D., Hedayioglu, F., Correia, R., Silva, T., Dutra, I., Almeida, F., Mattos, S. S. & Coimbra, M. 2011. Digiscope--Unobtrusive Collection And Annotating Of Auscultations In Real Hospital Environments. Conf Proc Ieee Eng Med Biol Soc, 2011, 1193-6.
  20. Rasheed, P., Koura, M. R., Al-Dabal, B. K. & Makki, S. M. 2008. Anemia In Pregnancy: A Study Among Attendees Of Primary Health Care Centers. Ann Saudi Med, 28, 449-52.
  21. Reidy, J. & Russell, R. 2011. Cmace 2006-2008. Int J Obstet Anesth, 20, 208-12.
  22. Ribeiro, A. L. P. A., M. B.; Cardoso, C. S. Et Al 2010. Implementation Of A Telecardiology System In The State Of Minas Gerais- The Minas Telecardio Project. Arq Bras Cardiol, 95, 70-78.
  23. Saúde., B. M. D. 2006. Estudo Da Mortalidade De Mulheres De 10 A 49 Anos, Com Ênfase Na Mortalidade Materna. In: Estratégicas, S. D. A. À. S. D. D. A. P. (Ed.). Brasília Brasil: Editora Do Ministério Da Saúde.
  24. Segall, H. N. 1963. Cardiovascular Sound And The Sthetoscope:1816 To 2016. Canad. Med. Ass. J., 88, 308-318.
  25. Shaver, J. A., Salerni, R. & Reddy, P. S. 1985. Normal And Abnormal Heart Sounds In Cardiac Diagnosis. Part I: Systolic Sounds. Curr Probl Cardiol, 10, 1-68.
  26. Silversides, C. K. C., J. M. 2007. Physiologic Changes In Pregnancy. In: Oakley, C. W., C. A. (Ed.) Heart Disease In Pregnancy. 2nd Ed. Ed. Malden, Ma Usa: Blackwell.
  27. Stout, K. K. & Otto, C. M. 2007. Pregnancy In Women With Valvular Heart Disease. Heart, 93, 552-8.
  28. Tavel, M. E. 1977. The Systolic Murmur--Innocent Or Guilty? Am J Cardiol, 39, 757-9.
  29. Tavel, M. E. 2006. Cardiac Auscultation: A Glorious Past-And It Does Have A Future! Circulation, 113, 1255- 9.
  30. Tavel, M. E. 2010. Cardiac Auscultation: A New Method For Instruction. Medical Education, 44, 1132-1132.
  31. Tavel, M. E. & Katz, H. 2005. Usefulness Of A New Sound Spectral Averaging Technique To Distinguish An Innocent Systolic Murmur From That Of Aortic Stenosis. Am J Cardiol, 95, 902-4.
  32. Tedoldi Cl, F. C., Bub Tf Et Al 2009. Diretriz Da Sociedade Brasileira De Cardiologia Para Gravidez Na Mulher Portadora De Cardiopatia. Arq Bras Cardiol, 93, E110-E178.
  33. Teixeira, P. 2010. Alterações Fisiológicas Da Gravidez. In: Atheneu (Ed.) Fundamentos E Prática Em Obstetrícia. 1a. Ed. Ed. Rio De Janeiro.
  34. Walter N. K. A Van Mook, L. P. 2005. <Severe Cardiac Disease In Pregnancy, Part I- Hemodynamic Changes And Complaints During Pregnancy, And General Management Of Cardiac Disease In Pregnancy.Pdf>. Curr Opin Crit Care, 11, 430-434.
  35. Http://Www.Telessaude.Hc.Ufmg.Br. Minas Telecárdio [Online]. [Accessed 02/06/2013.
  36. Zuhlke, L., Myer, L. & Mayosi, B. M. 2012. The Promise Of Computer-Assisted Auscultation In Screening For Structural Heart Disease And Clinical Teaching. Cardiovasc J Afr, 23, 405-8.

Paper Citation

in Harvard Style

Miranda Araújo M., Silveira Nogueira Reis Z., Baracho Porto R., Villas Freire C., Brito Goulart V., A. Fernandes F., Oliveira R. and Cruz-Correia R. (2013). Auscultatory Changes Identified through Digital Stethoscope and Echocardiographic Findings Associated with Healthy Pregnancy . In Proceedings of the International Congress on Cardiovascular Technologies - Volume 1: CARDIOTECHNIX, ISBN 978-989-8565-78-5, pages 39-46. DOI: 10.5220/0004637300390046

in Bibtex Style

author={Marilene Miranda Araújo and Zilma Silveira Nogueira Reis and Renata Baracho Porto and Cláudia Maria Villas Freire and Vitória Brito Goulart and Fabyulla A. Fernandes and Rosa Celeste Oliveira and Ricardo Cruz-Correia},
title={Auscultatory Changes Identified through Digital Stethoscope and Echocardiographic Findings Associated with Healthy Pregnancy},
booktitle={Proceedings of the International Congress on Cardiovascular Technologies - Volume 1: CARDIOTECHNIX,},

in EndNote Style

JO - Proceedings of the International Congress on Cardiovascular Technologies - Volume 1: CARDIOTECHNIX,
TI - Auscultatory Changes Identified through Digital Stethoscope and Echocardiographic Findings Associated with Healthy Pregnancy
SN - 978-989-8565-78-5
AU - Miranda Araújo M.
AU - Silveira Nogueira Reis Z.
AU - Baracho Porto R.
AU - Villas Freire C.
AU - Brito Goulart V.
AU - A. Fernandes F.
AU - Oliveira R.
AU - Cruz-Correia R.
PY - 2013
SP - 39
EP - 46
DO - 10.5220/0004637300390046