Appendix; Recording Techniques - Cardionics E-Scope II Operator's Manual

8.0 APPENDIX

8.1 Recording Techniques

The user should recognize that listening to heart or breath sounds and
recording them are different. Obtaining good recordings takes time and
practice.
To obtain a good recording, the stethoscope head should be taped to
the patient. We suggest double-faced Scotch tape with a hole, (3M
Double Stick Disks, part no. 2181). A hand touching the head of the
stethoscope will introduce noise into the recording. Below are some
additional tips on recording technique.
1. The room should be quiet. Many of the problems with recording
heart sounds result from not having a quiet room.
2. The patient should be relaxed as much as possible.
3. For a thorough examination, the patient should be in a sitting,
laying and left lateral recumbent position. For an adequate
examination, the recumbent position alone can be used, but listening
to the heart with the patient only in a sitting position is absolutely
inadequate. Typical diastolic murmurs of good intensity that are heard
when the patient is in the recumbent position may not be heard at all
when the patient is sitting.
In the recumbent position, the patient's arms must not be held over
the head, since this will elevate the rib cage and decrease the
intensity of the heart sound. Occasionally, it is an advantage to listen
with the patient in the prone position. This may be true in patients with
deep chests or those who may have a friction rub. This position may
be awkward when the patient is in bed or on the examining table and
supporting himself/herself on the elbows. It is much better to have the
patient stand up and lean over with his/her elbows on an examining
table. Muscle noise is at a minimum in this position and the patient
and examiner are much more comfortable. An important additional
advantage of this position is that the patient can be made to exercise
by touching his or her toes several times before he/she assumes the
position.
4. When the bell of the stethoscope is applied to the skin, the
enclosed skin forms a diaphragm. With increased pressure, the skin
diaphragm is made taut and its natural period of oscillation increases.
This improves the response to higher pitches, and at the same time
there is a general lowering of the sensitivity of the skin diaphragm. As
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