Best Stethoscope.

RE: Best Stethoscope.

Rob Loxley — Thu, 23 Nov 2017 15:23:11 GMT

[quote user="Bob Russell"]https://www.medisave.co.uk/diagnostics-equipment/littmann-stethoscopes.html[/quote]

And they've just spammed me with current black friday offer 10% off

RE: Best Stethoscope.

Julian Earl — Wed, 22 Nov 2017 13:57:58 GMT

I think the best for small animal use is the Littman paediatric. It does genuinely seem more sensitive for physically smaller animals such as cats, small dogs and presumably for human babies as well!

RE: Best Stethoscope.

Martin Atkinson — Wed, 22 Nov 2017 09:57:22 GMT

[quote user="Clive Ansell"] Saturday morning I had 6 puppies booked in a 20 minute slot for first vaccines, microchip, exam, complete paperwork and write full clinical notes,[/quote]That is the beauty of being a quiet sole-charge practice with no-one else dictating the pace, I can devote a lot more time

RE: Best Stethoscope.

Clive Ansell — Wed, 22 Nov 2017 09:27:41 GMT

[quote user="Martin Atkinson"][quote user="Clive Ansell"]In my 21 years in practice armed with my bog standard no bells or whistles Littmann classic stethoscope, I am only aware of missing one cardiac murmur, and indeed have detected murmurs that others haven't. [/quote]That's a bit of a QED answer - you don't know how many you missed if you weren't aware of them![/quote]

Fair enough. To put it another way, I am not aware of any cases going belly up because of missing a murmur, or anything else on auscultation.

[quote user="Martin Atkinson"][quote user="Clive Ansell"]The murmur I allegedly missed was in one of a litter of 8 or 9 Bull Mastiff puppies presented for first vaccines.[/quote]I had a similar experience at the very beginning of my career and leaned a salutary lesson. Every puppy is now thoroughly examined on first presentation for hernias, genitalia, teeth, extra digits and palatine abnormalities as well, albeit I wouldn't unleash the cardiac stethoscope unless there was a degree of suspicion.[/quote]

The problem with these is often being constrained by time. Saturday morning I had 6 puppies booked in a 20 minute slot for first vaccines, microchip, exam, complete paperwork and write full clinical notes, in addition to being short staffed, extra walk ins, and a crashing computer system. Almost impossible when only 3 minutes 20 seconds per puppy.

RE: Best Stethoscope.

Martin Atkinson — Wed, 22 Nov 2017 09:11:41 GMT

[quote user="Clive Ansell"]In my 21 years in practice armed with my bog standard no bells or whistles Littmann classic stethoscope, I am only aware of missing one cardiac murmur, and indeed have detected murmurs that others haven't. [/quote]That's a bit of a QED answer - you don't know how many you missed if you weren't aware of them!

[quote user="Clive Ansell"]The murmur I allegedly missed was in one of a litter of 8 or 9 Bull Mastiff puppies presented for first vaccines.[/quote]I had a similar experience at the very beginning of my career and leaned a salutary lesson. Every puppy is now thoroughly examined on first presentation for hernias, genitalia, teeth, extra digits and palatine abnormalities as well, albeit I wouldn't unleash the cardiac stethoscope unless there was a degree of suspicion. It is usually possible to detect cardiac murmurs with a cheaper stethoscope but they are just a lot clearer with a cardiac stethoscope. The downside of the latter is that you have to be more accurate with your placement or paradoxically you may miss one.

RE: Best Stethoscope.

Clive Ansell — Wed, 22 Nov 2017 09:09:08 GMT

[quote user="Bob Russell"]and a paediatric one (with a Cardiovet tag which ages it!).[/quote]

Nostalgia.

I've got one of those - it was from a full day Sunday CPD day back in 1996. I remember it very well, it was the first CPD I ever did just after graduation, involving lectures and practical work stations. I learnt more cardiology in that day than 5 years at university, including how to conduct a full and thorough clinical examination by Peter Darke no less. It was brilliant. It was pre Pimobendan of course, and ACEi were fairly new kids on the block.

RE: Best Stethoscope.

Clive Ansell — Wed, 22 Nov 2017 08:58:18 GMT

[quote user="Nicola M"]

May be a silly question but do you find any of these murmurs (that you can hear with cardio stethoscope but not standard ones) clinically significant?

I'm not being sarcastic-I'm genuinely interested. Are we missing a clinically important set of murmurs due to our stethoscope choice?

[/quote]

Not a silly question at all, in fact a very sensible one.

In my 21 years in practice armed with my bog standard no bells or whistles Littmann classic stethoscope, I am only aware of missing one cardiac murmur, and indeed have detected murmurs that others haven't.

The murmur I allegedly missed was in one of a litter of 8 or 9 Bull Mastiff puppies presented for first vaccines. The puppy was sold and the new owners vet detected a significant congenital murmur, resulting in a dispute between breeder and new owner. I still wonder whether the same puppy was actually presented (unable to prove or disprove), or whether I examined the same one twice or not in a large litter where they all look the same. Breeder was/is a dodgy character too. I now take more time to examine litters like that, and will record any findings along with a microchip number if there is one.

RE: Best Stethoscope.

Martin Atkinson — Wed, 22 Nov 2017 08:47:31 GMT

[quote user="David Mills"]

And just so the forum knows, he doesn't do echocardiography.

[/quote]Dear me what a petty, childish statement - sounds like you've not advanced since the playground David.

To say I don't do echo is rather a misleading statement. You're right I personally don't but as they say: I know a man who does! I refer to specialists which IMO carries a lot more weight than than the opinion of a GP who dabbles in it. And guess what, there is an almost perfect correlation in cases confirmed with functional cardiac disease with my clinical findings and other investigative techniques i.e. radiography, ECG and NT-proBNP. The only one I can recall that wasn't I asked for a review of the scan and they changed their minds so it still was. Heck I even used to perform cardiac contrast radiography before ultrasound was invented. What you have to realise David is that I was diagnosing heart disease before you were born and am a protege of Peter Darke, echo has just made it easier. You don't know how lucky you are........cue 4 Yorkshiremen!

RE: Best Stethoscope.

Clive Ansell — Wed, 22 Nov 2017 08:44:41 GMT

Thanks for all your thoughts, Littmann classic 3 it will be.

RE: Best Stethoscope.

Stephen Courtney — Tue, 21 Nov 2017 21:30:25 GMT

Arguments aside, i personally prefer the Littmans Paediatric sized head. The standard one is too large for cats, and the paediatric works well on cats and dogs too.

i use a small Littmans Infant sized one for really small creatures

RE: Best Stethoscope.

David Mills — Tue, 21 Nov 2017 20:54:56 GMT

There's quite a lot more on this to disprove the Atkinson theory

https://www.ncbi.nlm.nih.gov/m/pubmed/21029098/

And just so the forum knows, he doesn't do echocardiography.

RE: Best Stethoscope.

Michael Woodhouse — Tue, 21 Nov 2017 20:04:01 GMT

[quote user="David Mills"]

Incorrect again.

https://www.ncbi.nlm.nih.gov/m/pubmed/21075067/

Getting a bit of a pasting on here today

[/quote]

So, basically, if we treat these animals prophylactically many won't go on and develop overt cardiac disease, same outcome if we do

I honestly believe Martin believe's he's right but I'm pretty convinced it's a function of selective memory rather than genuine clinical effects. I don't think homeopaths think they are being fraudulent, they are misguided. I start to worry when either party won't accept this.......

RE: Best Stethoscope.

David Mills — Tue, 21 Nov 2017 19:58:51 GMT

[quote user="Martin Atkinson"]

[quote user="Thomas Johnson"]Does anyone have any more information on this?[/quote]The problem with these studies is that, apart from the second study you highlight, they do not take the age of the cat into consideration and even that one did not sub-divide them into groups in which the likelihood of cardiac disease developing is related to the age when the murmur was first detected.

My experience is that the majority of kittens with murmurs which are asymptomatic at that time will either have lost them by adulthood and/or they will not progress to clinical heart disease. Equally the majority of elderly cats which develop murmurs in their dotage when they were not present in middle age will remain asymptomatic. In cats whose murmurs were not picked up until young middle age, 1/3 will progress to clinical disease either due to ATE, CHF or sudden death due to HCM. This group is skewed by including cats which did have a murmur younger but it was not picked up. However in the subset of cats which first develop a murmur in young middle age the percentage which progress to clinical cardiac disease will be the majority, which fits with the overall figure in the second study.

[/quote]

Incorrect again.

https://www.ncbi.nlm.nih.gov/m/pubmed/21075067/

Getting a bit of a pasting on here today

RE: Best Stethoscope.

Martin Atkinson — Tue, 21 Nov 2017 15:36:04 GMT

RE: Best Stethoscope.

Michael Woodhouse — Tue, 21 Nov 2017 14:59:01 GMT

If you're doing farm work then the veterinary model is great with the longer tubing. Also easier with big dogs on the floor.

https://www.medisave.co.uk/diagnostics-equipment/littmann-stethoscopes/veterinary-stethoscope.html

Still won't go wrong with a Classic II SE or the new Classic III

https://www.medisave.co.uk/diagnostics-equipment/littmann-stethoscopes/classic-ii-se-stethoscope.html

https://www.medisave.co.uk/diagnostics-equipment/littmann-stethoscopes/littmann-classic-iii-stethoscopes.html

Advantage of the III is you can have it set up with a standard diaphragm and bell or a large and small diaphragm.

For cardiology I like the Welch Allyn Harvey Elite

https://www.welchallyn.com/content/welchallyn/americas/en/products/categories/physical-exam/auscultatory-exam--stethoscopes/cardiology-stethoscopes/harvey_elite_stethoscope.html

RE: Best Stethoscope.

Thomas Johnson — Tue, 21 Nov 2017 14:38:02 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]No, it's about 50:50[/quote]What: 50% of young middle aged cats with murmurs will have cardiac disease, or 50% of feline cardiac disease will be HCM?

[/quote]

There appears to be some disagreement in the literature about what proportion of cats with a murmur have cardiac disease, in this study only 53% of apparently healthy cats with a heart murmur had echocardiographic evidence of cardiac disease:

https://www.ncbi.nlm.nih.gov/pubmed/21276739

However in this study 88% of apparently healthy cats with a heart murmur had cardiac disease:

https://www.ncbi.nlm.nih.gov/pubmed/21141381

And then there's this study of 103 apparently healthy cats, 16 had a heart murmur but only 6 had cardiomyopathy:

https://www.ncbi.nlm.nih.gov/pubmed/19480619

Does anyone have any more information on this?

RE: Best Stethoscope.

Robin Grimmer — Tue, 21 Nov 2017 14:30:55 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]No, it's about 50:50[/quote]What: 50% of young middle aged cats with murmurs will have cardiac disease, or 50% of feline cardiac disease will be HCM?

[/quote]

The former. The latter would be a much higher percentage.

RE: Best Stethoscope.

Bob Russell — Tue, 21 Nov 2017 14:20:15 GMT

I would stick with a mid range Littmann. Plenty of bright, pretty colours and most places will personalise at no extra charge. Nurses have Classic III's which are very good!

I have the cardiology III and a paediatric one (with a Cardiovet tag which ages it!).

https://www.medisave.co.uk/diagnostics-equipment/littmann-stethoscopes.html

RE: Best Stethoscope.

Rob Loxley — Tue, 21 Nov 2017 13:48:55 GMT

[quote user="Clive Ansell"]Can anyone suggest which stethoscope would be best to buy for a vet student[/quote]

Littman classic? For small animals I like the infant size. Rarely use the bell side I have to say. I also have a Littman master which gets little use but is a bit more robust (thinking farms, horses etc).
I've never got on with either of the electronic stethoscopes we have at work.

RE: Best Stethoscope.

Martin Atkinson — Tue, 21 Nov 2017 12:35:08 GMT

[quote user="Robin Grimmer"]No, it's about 50:50[/quote]What: 50% of young middle aged cats with murmurs will have cardiac disease, or 50% of feline cardiac disease will be HCM?

RE: Best Stethoscope.

Robin Grimmer — Tue, 21 Nov 2017 12:26:30 GMT

[quote user="Martin Atkinson"]

the majority of cats which develop a murmur in young/middle age (2-5 yrs) will have significant cardiac disease, the vast majority of those will of course be HCM.

[/quote]

No, it's about 50:50

RE: Best Stethoscope.

Martin Atkinson — Tue, 21 Nov 2017 12:03:08 GMT

[quote user="David Mills"]the majority of cat murmurs are insignificant, [/quote]If you are counting them from infancy to old age you may be statistically correct but IME the majority of cats which develop a murmur in young/middle age (2-5 yrs) will have significant cardiac disease, the vast majority of those will of course be HCM.

[quote user="David Mills"]

....even when listened to with some expensive toy by people far more knowledgeable than me.

The Litmann Cardiology III is my staple, double headed and a very good stethoscope. Never used any others so can't comment on those.

[/quote]You don't have to be knowledgeable, just have ears - or maybe get a cardiac stethoscope!!

RE: Best Stethoscope.

David Mills — Tue, 21 Nov 2017 10:45:35 GMT

[quote user="Martin Atkinson"]I'm sure Dr Mills will come here soon and mock my approach to preemptive treatment of cats with HCM but c'est la vie.[/quote]

I've barely the energy, dear boy. "I'm going to treat your cat with some unproven, fairly pricey therapy, and I've no idea whether it will make a jot of difference - in fact all the studies looking at this have failed to pick up any functional, surrogate or other positive effects and people with this condition aren't started on these either. Would you like some magic crystals too?"

As Dr Atko will know, and a brief appraisal of the literature will tell you, the majority of cat murmurs are insignificant, and a large percentage of cats with significant heart disease don't have murmurs, even when listened to with some expensive toy by people far more knowledgeable than me.

The Litmann Cardiology III is my staple, double headed and a very good stethoscope. Never used any others so can't comment on those.

RE: Best Stethoscope.

Martin Atkinson — Tue, 21 Nov 2017 09:57:02 GMT

[quote user="Nicola M"]May be a silly question but do you find any of these murmurs (that you can hear with cardio stethoscope but not standard ones) clinically significant?[/quote]Given that I have a recent situation of a client with 2 sibling cats, one had a grade 2/6 murmur which I have preemptively treated and is hail and hearty while its brother which did not have a murmur which was audible on a standard stethoscope and was not preemptively treated went into CHF with HCM and despite the intervention of the QMH has died, I would say probably yes.

I'm sure Dr Mills will come here soon and mock my approach to preemptive treatment of cats with HCM but c'est la vie.

RE: Best Stethoscope.

Nicola Cole — Tue, 21 Nov 2017 09:30:33 GMT

[quote user="Martin Atkinson"]

I wouldn't get into any fancy stuff at this stage. I have a cardiology specific stethoscope with a solid head which will pick up murmurs inaudible with a standard bell/diaphragm type

[/quote]

May be a silly question but do you find any of these murmurs (that you can hear with cardio stethoscope but not standard ones) clinically significant?

I'm not being sarcastic-I'm genuinely interested. Are we missing a clinically important set of murmurs due to our stethoscope choice?