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  • 1 Department and Clinic of Internal Medicine, University of Veterinary Medicine Budapest, , István u. 2, H-1078Budapest, , Hungary
  • | 2 Mátyás Veterinary Centre, Dunaharaszti, , Hungary
  • | 3 SchiAb Veterinary Centre, Érd, , Hungary
  • | 4 Innomed Medical Co. Ltd., Budapest, , Hungary
Open access

Abstract

Electronic stethoscopes and digital phonocardiograms (DPCGs) can be applied when diagnosing cardiac murmurs, but their use for cardiac arrhythmias is not described in veterinary medicine. Data of 10 dogs are presented in this preliminary study, demonstrating the applicability of these techniques. Although the number of artefacts and the amount of baseline noise produced by the two digitising systems used did not differ, the Welch Allyn Meditron system or similar ones capable of simultaneous recording of electrocardiograms (ECGs) and DPCGs provide a better option for clinical research and education, whilst the 3M Littmann 3200 system might be more suitable for everyday clinical settings. A combined system with simultaneous phonocardiogram and ECG, especially with wireless transmission, might be a solution in the future.

Abstract

Electronic stethoscopes and digital phonocardiograms (DPCGs) can be applied when diagnosing cardiac murmurs, but their use for cardiac arrhythmias is not described in veterinary medicine. Data of 10 dogs are presented in this preliminary study, demonstrating the applicability of these techniques. Although the number of artefacts and the amount of baseline noise produced by the two digitising systems used did not differ, the Welch Allyn Meditron system or similar ones capable of simultaneous recording of electrocardiograms (ECGs) and DPCGs provide a better option for clinical research and education, whilst the 3M Littmann 3200 system might be more suitable for everyday clinical settings. A combined system with simultaneous phonocardiogram and ECG, especially with wireless transmission, might be a solution in the future.

Introduction

Cardiac auscultation plays a critical role in the clinical examination in human and veterinary medicine. It commonly helps identify cardiac murmurs and arrhythmias. The auscultatory findings can prompt further diagnostic techniques, e.g. thoracic radiography, echocardiography, and electrocardiography. Auscultation is safe, cheap, easy and quick, thus providing an excellent screening test for most dogs and cats. Furthermore, clinicians can gain valuable information about the underlying disease process and its severity based on auscultatory findings (Ljungvall et al., 2014; Caivano et al., 2018; Rishniw, 2018).

Various investigators have compared conventional stethoscopes (CS) and electronic stethoscopes (ES) for their ability to identify murmurs in people (Philip and Raemer, 1986; Grenier et al., 1998; Hoyte et al., 2005; Tavel, 2006) and dogs (Vörös et al., 2012; Szilvási et al., 2013). Furthermore, our group has also used both types of stethoscopes in a study on the occurrence of mitral valve insufficiency in healthy Beagle dogs (Vörös et al., 2015). However, only one study has focused on the sensitivity of electronic stethoscopes in identifying cardiac arrhythmias in people (Zenk et al., 2004). Blass et al. (2013) compared a digital, electronic stethoscope to a conventional, acoustic stethoscope for detecting cardiac murmurs and gallop sounds in cats. However, to the best of our knowledge, there are no studies on examining the diagnosis or characteristics of arrhythmias recorded by digital electronic stethoscopes.

In addition to the increased sensitivity of digital electronic stethoscopes, some have the capability to digitise analogue sound waves via an analogue/digital converter (Tavel, 2006; Germanakis et al., 2008; Vörös et al., 2011). These digitalised sounds can be transferred to a computer equipped with a proper software for recording, storing and further processing. The digitalised sounds can be displayed as digital phonocardiograms, which represent soundwaves as a time-amplitude graph, with or without a synchronous electrocardiogram (ECG) (Tavel, 2006; Germanakis et al., 2008). We have comprehensively described this methodology in our earlier publication on recording canine murmurs (Vörös et al., 2011).

Digital phonocardiograms allow clinicians to visualise and analyse heart murmurs (Tavel, 2006; Noponen et al., 2007; Germanakis et al., 2008; Vörös et al., 2011, 2012; Szilvási et al., 2013; Szilvási and Vörös, 2014), and they have been used in human patients with murmurs for nearly three decades (Tavel, 1996; Dahl et al., 2002; Germanakis et al., 2008). Our research group was the first to report the use of digital phonocardiograms in clinical settings for assessing canine murmurs (Vörös et al., 2011, 2012; Szilvási et al., 2013). Marinus et al. (2017) examined the ability of digital phonocardiography to differentiate innocent cardiac murmurs from those caused by congenital cardiac anomalies in puppies. Reisse (2008) and Fraune (2010) published digital phonocardiographic recordings of murmurs in cattle and horses, respectively. Ljungvall et al. (2009) examined the spectral characteristics of murmurs associated with mitral valve disease, whilst Kvart and Häggström (2002) published an audio textbook of heart sounds and murmurs that included numerous phonocardiograms which were possibly recorded in an analogue way, although the authors did not indicate their recording technique.

Based on the experiences and on the digitalised sound collections of our study group, a heart sound library of the most common canine cardiac murmurs was established in co-operation between the E-learning Consulting Department (Zelda) and the Small Animal Clinic of the University of Veterinary Medicine Hannover Foundation (TiHo), and the Department and Clinic of Internal Medicine of the University of Veterinary Medicine Budapest. This sound collection is freely available under the web site https://www.tiho-hannover.de/studium-lehre/zelda/e-learning-beratung/lernmedien-und-lernprogramme/heartsound-library (Vörös et al., 2010).

Digital phonocardiograms form an important part of cardiac pedagogy, and reports exist on using them in telecardiology in human medicine (Dahl et al., 2002; Germanakis et al., 2008; Mahnke et al., 2008; Germanakis and Kalmanti, 2009). Ehlers et al. (2010) reported favourable experiences when teaching veterinary students by listening to cardiac murmurs off-line, whilst providing digital phonocardiograms available with the free audio library described above with the teaching material.

Only one human study has examined the use of digital phonocardiography in the evaluation of cardiac arrhythmias (Zenk et al., 2004). A synchronous ECG should be recorded with the phonocardiogram; this is only possible with dedicated instruments, such as the Welch Allyn Meditron Electronic Stethoscope. In addition, visualisation of arrhythmias on the phonocardiogram is more susceptible to technical disturbances (artefacts) compared to recorded cardiac murmurs, based on our preliminary observations. Only one article describes the use of sound recordings of equine murmurs and arrhythmias recorded and played back in an analogue (traditional) way for education (Naylor et al., 2001). Digital phonocardiograms of arrhythmias might be more suitable for teaching students compared to traditional analogue sound recordings that lack synchronous ECGs.

Therefore, we sought to record canine arrhythmias using digital phonocardiography with simultaneously acquired ECGs and to compare their diagnostic value with the ECGs appearing on the phonocardiogram itself and with those recorded on a diagnostic multi-lead electrocardiograph.

We then compared the recording quality of two electronic stethoscopes for their ability to produce digital phonocardiograms that could be used for didactic or diagnostic purposes.

Materials and methods

Dogs and study design

We examined 32 dogs in order to adapt the digital phonocardiogram recording technique to cardiac arrhythmias. Of these, 25 dogs only had a physiological respiratory arrhythmia. These animals arrived at the Department and Clinic of Internal Medicine, University of Veterinary Medicine Budapest for various endoscopic (otoscopy, gastroscopy, respiratory examinations) procedures and to the SchiAb Veterinary Centre, Érd, Hungary for planned surgical interventions. Of these 25 dogs, 16 were anaesthetised before the planned endoscopy or surgery. In these cases, all animals underwent procedures requiring general anaesthesia, which were unrelated to our examination. Dogs were premedicated and induced with 0.5 mg/kg diazepam and 5 µg/kg dexmedetomidine iv. or with 0.5 mg/kg diazepam and 6 mg/kg ketamine. The inhalation anaesthesia was maintained with isoflurane. An analysis of cardiac alterations elicited by anaesthesia (e.g., bradycardia or atrioventricular blocks) did not belong to the goals of the present study. The remaining 9 dogs were examined awake.

Seven of the 32 dogs were presented for evaluation of cardiac disease. All seven dogs had tachyarrhythmias: atrial fibrillation (n = 2), atrial premature complexes (n = 2), ventricular premature complexes (n = 2) and paroxysmal ventricular tachycardia (n = 1). These dogs were examined without sedation.

In all cases, written consent was gained from each owner before starting the study. The implemented procedures were compliant with the guidance of the Animal Welfare Committee of the University of Veterinary Medicine, Budapest.

Physical examinations

All dogs underwent a detailed physical examination with special regard to the cardiorespiratory system. One investigator (KV) performed both conventional cardiac auscultation (with a Sprague Rappaport type conventional, acoustic stethoscope) and digital auscultation (with a 3M Littmann Electronic Stethoscope Model 3200 and a Meditron Welch Allyn electronic stethoscope).

Echocardiography

Echocardiography was performed as described for routine clinical echocardiography (Bonagura and Fuentes, 2015; Brown et al., 2015; Vörös et al., 2015).

Digital phonocardiography

Digital phonocardiograms were made and processed with the Welch Allyn Meditron Master Elite Stethoscope and Analyser System (Welch Allyn Corp., USA) as described earlier in humans and in dogs with cardiac murmurs (Germanakis et al., 2008; Vörös et al., 2011). This sound digitalising system includes the recording of synchronous, Einthoven lead II ECGs (Fig. 1).

Fig. 1.
Fig. 1.

Digital phonocardiogram (DPCG) of a healthy Beagle recorded with the Welch Allyn Meditron system. The X axis represents time, the Y axis represents the amplitudes/wave forms of the heart sounds. The upper part of the image shows the simultaneously recorded (synchronous) Einthoven lead 2 bipolar electrocardiogram (ECG). S1: Heart sound 1, S2: Heart sound 2. (From Vörös et al.: Acta Vet. Hung. 2011; 59, 23–35, with permission)

Citation: Acta Veterinaria Hungarica 69, 2; 10.1556/004.2021.00024

The digital files were stored and analysed on a personal computer as .wav (16-bit waveform) files. These Meditron .wav files contain both the simultaneous ECG (left channel) and sound (right channel) data and were replayed and analysed with the dedicated software of the Welch Allyn Meditron digitising software. The .wav files were converted to conventional .wav and .mp3 files by using the freely available shareware program Audacity® (https://www.audacityteam.org). The original Meditron digital phonocardiogram video recordings were also converted from the original Meditron .wav files into video .mpg files with the CamStudioTM (www.camstudio.org), similarly to the digital phonocardiogram recordings of the cardiac murmurs that can be found in our heart sound library (Vörös et al., 2010).

Awake dogs were examined standing, with two adhesive flat ECG electrodes fixed with Ramofix flexible band on the thorax and one on the left gluteal region (Fig. 2) as reported earlier by Szilvási and Vörös (2014). The three electrodes allow the recording of modified versions of the conventional Einthoven bipolar leads, with Lead II corresponding to the signal produced by the white and red electrodes. This was made to provide good-quality recordings in standing animals as shown on Fig. 2. Sedated dogs were examined in right lateral recumbency with the Welch Allyn Meditron system, where clip electrodes on the limbs were used for recording the ECG signals as the traditional method (Edwards, 1987; Tilley and Burtnick, 2009). In this group, recordings were also obtained with the 3M Littmann Electronic Stethoscope Model 3200 to produce digital phonocardiograms with the relevant software, as described by Marinus et al. (2017).

Fig. 2.
Fig. 2.

Fixation of the ECG adhesive electrodes to the chest and to the hip region using Ramofix flexible band. The A/D converter, which transmits the digitalised sounds to the computer, can be seen beside the dog, along with its electrode cables. (From Szilvási and Vörös: Magy. Allatorvosok 2014; 136, 291–299, with permission)

Citation: Acta Veterinaria Hungarica 69, 2; 10.1556/004.2021.00024

Electrocardiography

An Innobase Pico type 7-channel Holter ECG (Innomed Medical Inc., Hungary) was used, equipped with clamp electrodes to follow cardiac function and rhythm during the study. Standard bipolar Einthoven I, II, III as well as unipolar Goldberger aVR, aVL, aVF leads, and one Wilson thoracic (precordial) lead were recorded simultaneously with this instrument. Together with the Holter recordings, the Welch Allyn Meditron system was also used to produce synchronous ECG curves parallel with the digitalised phonocardiograms. To compare the events on the Holter ECGs with the digital phonocardiogram recordings, we created a unique artefact on the Holter ECG recording at the start of the digital phonocardiogram recording by touching and moving one of the electrodes by hand for 1 s.

Comparison and analysis of the ECGs and Welch Allyn digital phonocardiograms

The ECG recordings were examined based on two parameters: (1) deviation from the baseline, and (2) the number of artefacts.

On the ECG recordings of the Holter instrument and on the digital phonocardiograms, the maximal baseline deflection was calculated, by measuring the difference between maximal and minimal points of the baseline on the Y axis, presented in mV. For the Welch Allyn Meditron electronic stethoscope, only a single, transthoracic bipolar ECG was recorded and evaluated (Fig. 3). For Holter-produced ECGs, all seven leads were examined (Fig. 4).

Fig. 3.
Fig. 3.

Measurement of the ECG baseline deviation on a digital phonocardiogram (DPCG) recorded with the Welch Allyn Meditron system. The baseline deviation is the difference between the highest (upper, smaller horizontal line) and the lowest (lower horizontal line) points of the baseline, in mV. S1: first heart sound, S2: second heart sound

Citation: Acta Veterinaria Hungarica 69, 2; 10.1556/004.2021.00024

Fig. 4.
Fig. 4.

Measurement of the ECG baseline deviation of Einthoven bipolar lead 1 on an ECG recording made with the Innomed Holter ECG system. The baseline deviation is the difference between the highest (upper, smaller horizontal line) and the lowest (lower, horizontal line) points of the baseline, in (1) mV

Citation: Acta Veterinaria Hungarica 69, 2; 10.1556/004.2021.00024

Artefacts were counted over a 12-sec period, in a manner consistent with the examination of baseline deviation, on the single lead in the case of Meditron recordings, and on all seven leads in the case of Holter recordings. Because artefacts tend to be absent in some leads on the 7-lead ECG, we examined all seven leads separately.

We then examined the ECGs of the seven dogs with pathological arrhythmias by comparing the presence of the extrasystole on ECG and digital phonocardiogram recorded simultaneously by the Welch Allyn Meditron system with the extrasystole present on the 7-lead Holter ECG.

Comparison of digital stethoscopes

We then compared digital phonocardiograms recorded by Welch Allyn Meditron and Littmann digital stethoscopes in 10 cases. First, we measured baseline noise and heart sound amplitude, using an image editing software (Adobe Photoshop CC 2018). We constructed a ratio of average S1 amplitude in pixels to average baseline noise amplitude. With this ratio, a high value means a more distinguishable heart sound. We then counted the number of artefacts over a 12-sec period.

Statistical analyses

We compared the counts of artefacts between the two electronic stethoscopes by Mann–Whitney U tests, corrected for small sample sizes, because only one dog had data obtained by both stethoscopes. We compared the artefacts between the Welch Allyn Meditron and the Holter ECGs using Signed Ranks tests, corrected for small sample sizes. All statistical analyses were performed using a free online statistical calculator (http://vassarstats.net/).

Results

Technique and applicability of ECG and digital phonocardiogram recording methods of arrhythmias

We could only obtain standardised, reproducible data from 10 out of the 16 sedated dogs.

In general, we obtained good-quality ECGs in the 9 standing, awake dogs and in the 10 sedated dogs using the ECG system of the Meditron Welch Allyn electronic stethoscope.

Both electronic stethoscopes produced phonocardiograms that allowed identification of the cardiac rhythm in all 10 cases included in the study (Table 1). Even in cases with higher baseline noise, we could identify a physiologic heartbeat from the digital phonocardiogram or the corresponding ECG. We found that the Meditron Welch Allyn electronic stethoscope produced recordings of reasonable quality (where both baseline noise and artefact count could be evaluated) in five cases, but not in the other five. Single examples of good- and bad-quality recordings are presented in Figs 5 and 6, respectively. On the other hand, we found it harder to create digital phonocardiograms of adequate quality with the Littmann 3200 electronic stethoscope which produced 3 adequate and 7 inadequate quality recordings (Fig. 7).

Table 1.

Baseline deviation of the ECG signals on the Innomed Holter and on the Welch Allyn Meditron DPCG recordings

CaseBreedAge (year)ECG diagnosisInnomed Holter (mV)Welch Allyn Meditron (mV)
1Doberman Pinscher5PSA3.9X
2American Bulldog0.3SR1.140.3
3Mixed breed1PSA2.90.01
4Rottweiler4PVT5.80.1
5Cane Corso3SRXX
6German Shepherd Dog2SR10.50
7Chihuahua3SR7.4X
8English Bulldog0.9SR19.70.1
9Bichon Havanese9SR10.2
10Mixed breed0.9PSAX0.5

mV: millivolts; PSA: physiologic sinus arrhythmia; SR: sinus rhythm; PVT: paroxysmal ventricular tachycardia; X: baseline deviation could not be evaluated due to high noise.

Fig. 5.
Fig. 5.

Good-quality DPCG and ECG recording of a dog with paroxysmal ventricular tachycardia. The run of ventricular extrasystoles with abnormal ECG complexes is marked with the text VES whereas normal beats are marked with N. Note the seemingly random amplitude of both S1 and S2 beats on the DPCG during the VES episodes, and the relatively constant S1 and S2 amplitudes on the normal segments. Recording was made by the Welch Allyn Meditron Electronic Stethoscope

Citation: Acta Veterinaria Hungarica 69, 2; 10.1556/004.2021.00024

Fig. 6.
Fig. 6.

Poor-quality DPCG with a large amount of baseline noise (red arrows) and ECG baseline deflection (as visible on the irregular baseline) of a dog with sinus tachycardia. Recording was made by the Welch Allyn Meditron Electronic Stethoscope. Note: the patient did not show signs of heart murmur that would explain DPCG baseline noise

Citation: Acta Veterinaria Hungarica 69, 2; 10.1556/004.2021.00024

Fig. 7.
Fig. 7.

Poor-quality DPCG with a very large amount of baseline noise, preventing the ability to properly interpret the results. Recording was made by the Littmann 3200 Electronic Stethoscope, from the same dog as in Fig. 6. Note: the patient did not show signs of heart murmur that would explain DPCG baseline noise

Citation: Acta Veterinaria Hungarica 69, 2; 10.1556/004.2021.00024

Comparison of the Welch Allyn Meditron and the Holter systems for ECG recording of arrhythmias

The ECGs obtained with the Welch Allyn Meditron electronic stethoscope and the Holter ECG demonstrated substantial baseline artefact which affected interpretation of the ECG in 20–30% of the cases. Overall – when not on a level that prevented interpretation – the Welch Allyn Meditron ECG appeared to have a smaller baseline artefact than the Holter ECG, although we did not make a statistical comparison of the amplitude of the artefact.

In five cases, the high baseline noise hindered artefact counting (marked with an X in Table 2). The number of artefacts on ECGs produced by the Welch Allyn Meditron and the Holter ECG where we could obtain counts did not differ (W = 17, critical W = 21).

Table 2.

Comparison of the number of artefacts of the ECG signals on the Innomed Holter and on the Welch Allyn Meditron DPCG recordings. The numbers represent the count of artefacts

CaseBreedInnomed HolterWelch Allyn MeditronECG diagnosis
1Doberman Pinscher0XPSA
2American Bulldog01SR
3Mixed breed21PSA
4Rottweiler20PVT
5Cane CorsoXXSR
6German Shepherd Dog30SR
7Chihuahua2XSR
8English Bulldog20SR
9Bichon Havanese10SR
10Mixed breedX1PSA

PSA: physiologic sinus arrhythmia; SR: sinus rhythm; PVT: paroxysmal ventricular tachycardia; X: artefact number could not be evaluated due to high baseline noise.

Comparison of the Welch Allyn Meditron and the 3M Littmann 3200 systems for digital phonocardiographic recording of arrhythmias

There was no significant difference between the noise produced by the two systems (Table 3). Over 50% of the cases examined with either stethoscope had such high noise (marked with X) that we were unable to count the number of artefacts. The number of artefacts produced by the Welch Allyn Meditron and the 3M Littmann 3200 electronic stethoscopes did not differ (UA:10.5, Critical UA: 1 to 14) (Table 4).

Table 3.

Comparison of the baseline noise on the digital phonocardiogram recordings with the Welch Allyn Meditron and with the 3M Littmann 3200 electronic stethoscopes. Values show the ratio between the highest audible heart sound to the baseline noise in pixels. Higher values mean lower noise

CaseBreedWelch Allyn Meditron3M Littmann 3200ECG diagnosis
1Doberman PinscherX5.6PSA
2American Bulldog3.5XSR
3Mixed breed19.26PSA
4RottweilerXXPVT
5Cane CorsoX6.5SR
6German Shepherd Dog12.9XSR
7ChihuahuaX4.2SR
8English Bulldog6.1XSR
9Bichon HavaneseXXSR
10Mixed breed5.9XPSA

PSA: physiologic sinus arrhythmia; SR: sinus rhythm; PVT: paroxysmal ventricular tachycardia; X: Signal-to-noise could not be evaluated due to the quality of the recording.

Table 4.

Comparison of the count of artefacts on the DPCG recordings made with the Welch Allyn Meditron and with the 3M Littmann 3200 systems

CaseBreedWelch Allyn Meditron3M Littmann 3200ECG diagnosis
1Doberman PinscherX7PSA
2American Bulldog12XSR
3Mixed breed212PSA
4RottweilerXXPVT
5Cane CorsoX11SR
6German Shepherd Dog3XSR
7ChihuahuaXXSR
8English Bulldog9XSR
9Bichon HavaneseXXSR
10Mixed breed10XPSA

PSA: physiologic sinus arrhythmia; SR: sinus rhythm; PVT: paroxysmal ventricular tachycardia; X: Could not be evaluated due to the quality of the recording.

Discussion

Our study shows that electronic stethoscopes produce considerable auditory artefacts, but we were able to discern cardiac rhythms in many cases despite these artefacts. Furthermore, the Welch Allyn Meditron, which includes an ECG that can be acquired simultaneously, provides a better means of analysing arrhythmias than the 3M Littmann 3200 electronic stethoscope, which does not provide simultaneous ECG recording. Neither stethoscope produced more or fewer phonocardiographic artefacts than the other; however, the number of cases that we could analyse was extremely low.

We previously showed that the Welch Allyn Meditron electronic stethoscope provided good-quality digital phonocardiograms of canine cardiac murmurs which were helpful in their diagnosis (Vörös et al., 2011). Based on our preliminary experiences with electronic stethoscopes and digital phonocardiography in the present study, these systems can help detect and document canine arrhythmias, in the same way as cardiac murmurs (Vörös et al., 2011; Szilvási et al., 2013; Marinus et al., 2017).

We used adhesive ECG electrodes while recording the phonocardiograms with the Welch Allyn Meditron to avoid artefacts caused by movement while auscultating dogs in a standing position (Vörös et al., 2011). However, unlike the auscultation of murmurs, the auscultation of arrhythmias does not depend on specific auscultatory locations and correct positioning of the dog (standing) but can be performed in right lateral recumbency which would allow standard ECG recording.

When comparing the two techniques, phonocardiograms recorded by the 3M Littmann 3200 stethoscope were less reliable for analysing arrhythmias, because, subjectively, the artefacts produced with this stethoscope made it difficult to identify true arrhythmias (Fig. 7). In addition, this stethoscope has a shorter recording period, which could limit arrhythmia detection. As the 3M Littmann 3200 stethoscope does not have a possibility to record synchronous ECGs on the phonocardiograms, ventricular systole and diastole can only be distinguished by identifying the 1st and the 2nd sounds on the phonocardiograms (Blass et al., 2013; Marinus et al., 2017). The identification of additional heart sounds becomes a challenge without synchronous ECG recordings and extrasystoles, even if identified, cannot be differentiated as originating from the atria or the ventricles.

On the other hand, the 3M Littmann 3200 system seems to be easier to use due to its Bluetooth connection (<10 m) to the computing device (computer and the relevant software).

For teaching and clinical research of pathological arrhythmias, the Welch Allyn Meditron system is more suitable because of its capability of synchronous phonocardiographic and ECG recordings on the digital phonocardiograms (Vörös et al., 2011; Szilvási and Vörös, 2014) as well as because of its reduced background noise due to noise filtering. This electronic stethoscope also provides audio recordings along with the phonocardiograms and ECGs. Consequently, the visual data accompanying the auditory data can help the listener to understand the sounds being auscultated (Ehlers et al., 2010; Vörös et al., 2010, 2011). Similarly, Naylor et al. (2001) used analogue (traditional) sound recordings of heart murmurs and arrhythmias of horses for teaching purposes with good results. To the best of our knowledge, there is no other similar publication in the literature.

Further digitalising techniques like spectral analysis, acoustic cardiography, and spectrophonocardiography – which are beyond the scope of this paper – can be used in the clinical research and teaching of cardiology (Tavel and Katz, 2005; Höglund et al., 2007; Ljungvall et al., 2009; Wen et al., 2014). A promising technique involves smartphone digital phonocardiography (Leng et al., 2015; Thoms et al., 2017).

Our study has some limitations as well, like the low number of cases analysed in detail and presented in the tables. We did not attempt to analyse the particular arrhythmias elicited by anaesthetic drugs, as this was not among the goals of the present study. As such, the different anaesthetic protocols used in our study did not influence our technical results.

Further noise reduction is also challenging with native phonocardiograms produced by the Welch Allyn Meditron electronic stethoscope, as neither Audacity, nor Adobe Audition FFT (Fourier Transform Filter) filters support a single channel application (the audio channel, with the ECG tracings being recorded in the second channel).

It is worth noting that the Welch Allyn Meditron is no longer produced; therefore, some of the artefact issues we observed might have been addressed with newer electronic stethoscopes that might include better filters both for the audio signals and the ECG signals. The 3M Littmann 3200 remains available but has not been updated to include a simultaneous ECG recording.

Our preliminary observations suggest that electronic stethoscopes, when coupled with simultaneously obtained ECG recordings, might help educate veterinary students about cardiac arrhythmias as well as murmurs.

Acknowledgement

This study was supported by the Doctoral School of the University of Veterinary Medicine Budapest as part of the doctoral thesis of the first author.

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  • Ljungvall, I., Rishniw, M., Porciello, F., Ferasin, L. and Ohad, D. G. (2014): Murmur intensity in small-breed dogs with myxomatous mitral valve disease reflects disease severity. J. Small Anim. Pract. 55 ,545550.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mahnke, C. B., Mulreany, M. P., Inafuku, J., Abbas, M., Feingold, B. and Paolillo, J. A. (2008): Utility of store-and-forward pediatric telecardiology evaluation in distinguishing normal from pathologic pediatric heart sounds. Clin. Pediatr. 47 ,919925.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Marinus, S. M., van Engelen, H. and Szatmári, V. (2017): N-Terminal Pro-B-type natriuretic peptide and phonocardiography in differentiating innocent cardiac murmurs from congenital cardiac anomalies in asymptomatic puppies. J. Vet. Intern. Med. 31 ,661667.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Naylor, J. M., Yadernuk, L. M., Pharr, J. W. and Ashburner, J. S. (2001): An assessment of the ability of diplomates, practitioners, and students to describe and interpret recordings of heart murmurs and arrhythmia. J. Vet. Intern. Med. 15 ,507515.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Noponen, A-L., Lukkarinen, S., Angerla, A. and Sepponen, R. (2007): Phono-spectrographic analysis of heart murmur in children. BMC Pediatr. 7 ,23.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Philip, J. H. and Raemer, D. B. (1986): An electrical stethoscope is judged better than conventional stethoscopes for anesthesia monitoring. J. Clin. Monit. 2 ,151154.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reisse, A. (2008): Phonocardiographic Investigations of Heart Murmurs in Cattle [in German]. Dissertation. Ludwig Maximilian University, Faculty of Veterinary Medicine, Munich.

  • Rishniw, M. (2018): Murmur grading in humans and animals: past and present. J. Vet. Card. 20 ,223233.

  • Szilvási, V. and Vörös, K. (2014): Application of sensor-based electronic stethoscopes and digital phonocardiography in canine cardiology [in Hungarian, with English abstract]. Magy. Allatorvosok 136 ,291299.

    • Search Google Scholar
    • Export Citation
  • Szilvási, V., Vörös, K., Manczur, F., Reiczigel, J., Novák, I., Máthé, Á. and Fekete, D. (2013): Comparison of traditional and sensor-based electronic stethoscopes in Beagle dogs. Acta Vet. Hung. 61, 1929.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tavel, M. E. (1996): Cardiac auscultation. A glorious past – but does it have a future? Circulation 93 ,12501253.

  • Tavel, M. E. (2006): Cardiac auscultation. A glorious past – and it does have a future! Circulation 113 ,12551259.

  • Tavel, M. E. and 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 ,902904.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Thoms, L-J., Colicchia, G. and Girwidz, R. (2017): Phonocardiography with a smartphone. Phys. Educ. 52 ,023004.

  • Tilley, L. P. and Burtnick, N. L. (2009): ECG for the Small Animal Practitioner. Made Easy Series. Teton New Media, Jackson, USA. pp. 1732.

    • Search Google Scholar
    • Export Citation
  • Vörös, K., Balogh, M., Kleinsorgen, Ch., Manczur, F. and Nolte, I. (2010): Heartsound library. https://www.tiho-hannover.de/studium-lehre/zelda/e-learning-beratung/lernmedien-und-lernprogramme/heartsound-library) Last accessed: 29 April 2020.

    • Search Google Scholar
    • Export Citation
  • Vörös, K., Bonnevie, A. and Reiczigel, J. (2012): Comparison of conventional and sensor-based electronic stethoscopes in detecting cardiac murmurs of dogs. Tierärztl. Prax. Ausgabe K, Kleintiere Heimtiere 40 ,103111.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vörös, K., Nolte, I., Hungerbühler, S., Reiczigel, J., Ehlers, J. P., Tater, G., Mischke, R., Zimmering, T. and Schneider, M. (2011): Sound recording and digital phonocardiography of cardiac murmurs in dogs by using a sensor-based electronic stethoscope. Acta Vet. Hung. 59 ,2335.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vörös, K., Szilvási, V., Manczur, F., Máthé, Á., Reiczigel, J., Nolte, I., Hungerbühler, S. (2015): Occurrence of mitral valve insufficiency in clinically healthy Beagle dogs. Acta Vet. Hung. 63 ,458471.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wen, Y. N., Lee, A. P., Fang, F., Jin, C. N. and Yu, C. M. (2014): Beyond auscultation: acoustic cardiography in clinical practice. Int. J. Cardiol. 172 ,548560.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zenk, B. M., Bratton, R. L., Flipse, T. R., and Page, E. E. (2004): Accuracy of detecting irregular cardiac rhythms via telemedicine. J. Telemed. Telecare 10 ,5458.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Blass, K. A., Schober, K. E., Bonagura, J. D., Scansen, B. A., Visser, L. C., Lu, J. and Smith, N. D. (2013): Clinical evaluation of the 3M Littmann Electronic Stethoscope Model 3200 in 150 cats. J. Feline Med. Surg. 15 ,893900.

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  • Bonagura, J. D. and Fuentes, W. L. (2015): Echocardiography. In: Nyland, T. G. and Mattoon, J. S. (eds) Small Animal Diagnostic Ultrasound. 3rd edition. Elsevier Saunders, St. Louis. pp. 217331.

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  • Brown, D., Gaillot, H. and Cunningham, S. (2015): Heart. In: Penninck, D. and d’Anjou, M. A. (eds). Atlas of Small Animal Ultrasonography. 2nd edition. Blackwell Publishing, Ames. pp. 111181.

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  • Caivano, D., Dickson, D., Martin, M. and Rishniw, M. (2018): Murmur intensity in adult dogs with pulmonic and subaortic stenosis reflects disease severity. J. Small Anim. Pract. 59 ,161166.

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  • Dahl, L. B., Hasvold, P., Arild, E. and Hasvold, T. (2002): Heart murmurs recorded by a sensor based electronic stethoscope and e-mailed for remote assessment. Arch. Dis. Child. 87 ,297301.

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  • Edwards, N. J. (1987): Bolton’s Handbook of Canine and Feline Electrocardiography. 2nd edition. W. B. Saunders, Philadelphia. pp. 1631.

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  • Fraune, A. (2010): Phono- and Echocardiographic Monitoring for the Evaluation of Heart Murmurs in Horses [in German]. Dissertation. Faculty of Veterinary Medicine, Free University of Berlin.

  • Germanakis, I., Dittrich, S., Perakaki, R. and Kalmanti, M. (2008): Digital phonocardiography as a screening tool for heart disease in childhood. Acta Pediatr. 97 ,470473.

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  • Germanakis, I. and Kalmanti, M. (2009): Paediatric cardiac auscultation teaching based on digital phonocardiography. Med. Educ. 43 ,489.

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  • Grenier, M. C., Gagnon, K., Genest, J., Durand, J. and Durand, L-G. (1998): Clinical comparison of acoustic and electronic stethoscopes and design of a new electronic stethoscope. Am. J. Cardiol. 81 ,653656.

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  • Hoyte, H., Jensen, T. and Gjesdal, K. (2005): Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes. BMC Med. Ed. 5 ,14.

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  • Höglund, K., Ahlstrom, C. H. G., Häggström, J., Ask, P. N. A., Hult, P. H. P. and Kvart, C. (2007): Time-frequency and complexity analyses for differentiation of physiologic murmurs from heart murmurs caused by aortic stenosis in Boxers. Am. J. Vet. Res. 68 ,962969.

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  • Kvart, C. and Häggström, J. (2002): Cardiac Auscultation and Phonocardiography in Dogs, Horses and Cats. TK i Uppsala AB, Uppsala. pp. 1320.

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  • Leng, S., Tan, R. S., Chai, K. T. C., Wang, C., Ghista, D. and Zhong, L. (2015): The electronic stethoscope. BioMed. Eng. OnLine 14 ,66.

  • Ljungvall, I., Ahlstrom, C., Höglund, K., Hult, P., Kvart, C., Borgarelli, M., Ask, P. and Häggström, J. (2009): Use of signal analysis of heart sounds and murmurs to assess severity of mitral valve regurgitation attributable to myxomatous mitral valve disease in dogs. Am. J. Vet. Res. 70 ,604613.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ljungvall, I., Rishniw, M., Porciello, F., Ferasin, L. and Ohad, D. G. (2014): Murmur intensity in small-breed dogs with myxomatous mitral valve disease reflects disease severity. J. Small Anim. Pract. 55 ,545550.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mahnke, C. B., Mulreany, M. P., Inafuku, J., Abbas, M., Feingold, B. and Paolillo, J. A. (2008): Utility of store-and-forward pediatric telecardiology evaluation in distinguishing normal from pathologic pediatric heart sounds. Clin. Pediatr. 47 ,919925.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Marinus, S. M., van Engelen, H. and Szatmári, V. (2017): N-Terminal Pro-B-type natriuretic peptide and phonocardiography in differentiating innocent cardiac murmurs from congenital cardiac anomalies in asymptomatic puppies. J. Vet. Intern. Med. 31 ,661667.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Naylor, J. M., Yadernuk, L. M., Pharr, J. W. and Ashburner, J. S. (2001): An assessment of the ability of diplomates, practitioners, and students to describe and interpret recordings of heart murmurs and arrhythmia. J. Vet. Intern. Med. 15 ,507515.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Noponen, A-L., Lukkarinen, S., Angerla, A. and Sepponen, R. (2007): Phono-spectrographic analysis of heart murmur in children. BMC Pediatr. 7 ,23.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Philip, J. H. and Raemer, D. B. (1986): An electrical stethoscope is judged better than conventional stethoscopes for anesthesia monitoring. J. Clin. Monit. 2 ,151154.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reisse, A. (2008): Phonocardiographic Investigations of Heart Murmurs in Cattle [in German]. Dissertation. Ludwig Maximilian University, Faculty of Veterinary Medicine, Munich.

  • Rishniw, M. (2018): Murmur grading in humans and animals: past and present. J. Vet. Card. 20 ,223233.

  • Szilvási, V. and Vörös, K. (2014): Application of sensor-based electronic stethoscopes and digital phonocardiography in canine cardiology [in Hungarian, with English abstract]. Magy. Allatorvosok 136 ,291299.

    • Search Google Scholar
    • Export Citation
  • Szilvási, V., Vörös, K., Manczur, F., Reiczigel, J., Novák, I., Máthé, Á. and Fekete, D. (2013): Comparison of traditional and sensor-based electronic stethoscopes in Beagle dogs. Acta Vet. Hung. 61, 1929.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tavel, M. E. (1996): Cardiac auscultation. A glorious past – but does it have a future? Circulation 93 ,12501253.

  • Tavel, M. E. (2006): Cardiac auscultation. A glorious past – and it does have a future! Circulation 113 ,12551259.

  • Tavel, M. E. and 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 ,902904.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Thoms, L-J., Colicchia, G. and Girwidz, R. (2017): Phonocardiography with a smartphone. Phys. Educ. 52 ,023004.

  • Tilley, L. P. and Burtnick, N. L. (2009): ECG for the Small Animal Practitioner. Made Easy Series. Teton New Media, Jackson, USA. pp. 1732.

    • Search Google Scholar
    • Export Citation
  • Vörös, K., Balogh, M., Kleinsorgen, Ch., Manczur, F. and Nolte, I. (2010): Heartsound library. https://www.tiho-hannover.de/studium-lehre/zelda/e-learning-beratung/lernmedien-und-lernprogramme/heartsound-library) Last accessed: 29 April 2020.

    • Search Google Scholar
    • Export Citation
  • Vörös, K., Bonnevie, A. and Reiczigel, J. (2012): Comparison of conventional and sensor-based electronic stethoscopes in detecting cardiac murmurs of dogs. Tierärztl. Prax. Ausgabe K, Kleintiere Heimtiere 40 ,103111.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vörös, K., Nolte, I., Hungerbühler, S., Reiczigel, J., Ehlers, J. P., Tater, G., Mischke, R., Zimmering, T. and Schneider, M. (2011): Sound recording and digital phonocardiography of cardiac murmurs in dogs by using a sensor-based electronic stethoscope. Acta Vet. Hung. 59 ,2335.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vörös, K., Szilvási, V., Manczur, F., Máthé, Á., Reiczigel, J., Nolte, I., Hungerbühler, S. (2015): Occurrence of mitral valve insufficiency in clinically healthy Beagle dogs. Acta Vet. Hung. 63 ,458471.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wen, Y. N., Lee, A. P., Fang, F., Jin, C. N. and Yu, C. M. (2014): Beyond auscultation: acoustic cardiography in clinical practice. Int. J. Cardiol. 172 ,548560.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zenk, B. M., Bratton, R. L., Flipse, T. R., and Page, E. E. (2004): Accuracy of detecting irregular cardiac rhythms via telemedicine. J. Telemed. Telecare 10 ,5458.

    • Crossref
    • Search Google Scholar
    • Export Citation

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Senior editors

Editor-in-Chief: Mária BENKŐ

Managing Editor: András SZÉKELY

Editorial Board

  • Béla DÉNES (National Food Chain Safety Office, Budapest Hungary)
  • Edit ESZTERBAUER (Veterinary Medical Research Institute, Budapest, Hungary)
  • Hedvig FÉBEL (National Agricultural Innovation Centre, Herceghalom, Hungary)
  • László FODOR (University of Veterinary Medicine, Budapest, Hungary)
  • Balázs HARRACH (Veterinary Medical Research Institute, Budapest, Hungary)
  • Peter MASSÁNYI (Slovak University of Agriculture in Nitra, Nitra, Slovak Republic)
  • Béla NAGY (Veterinary Medical Research Institute, Budapest, Hungary)
  • Tibor NÉMETH (University of Veterinary Medicine, Budapest, Hungary)
  • Zsuzsanna NEOGRÁDY (University of Veterinary Medicine, Budapest, Hungary)
  • Alessandra PELAGALLI (University of Naples Federico II, Naples, Italy)
  • Kurt PFISTER (Ludwig-Maximilians-University of Munich, Munich, Germany)
  • László SOLTI (University of Veterinary Medicine, Budapest, Hungary)
  • József SZABÓ (University of Veterinary Medicine, Budapest, Hungary)
  • Péter VAJDOVICH (University of Veterinary Medicine, Budapest, Hungary)
  • János VARGA (University of Veterinary Medicine, Budapest, Hungary)
  • Štefan VILČEK (University of Veterinary Medicine in Kosice, Kosice, Slovak Republic)
  • Károly VÖRÖS (University of Veterinary Medicine, Budapest, Hungary)
  • Herbert WEISSENBÖCK (University of Veterinary Medicine, Vienna, Austria)
  • Attila ZSARNOVSZKY (Szent István University, Gödöllő, Hungary)

ACTA VETERINARIA HUNGARICA
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Centre for Agricultural Research
Hungarian Academy of Sciences
P.O. Box 18, H-1581 Budapest, Hungary
Phone: (36 1) 467 4081 (ed.-in-chief) or (36 1) 213 9793 (editor) Fax: (36 1) 467 4076 (ed.-in-chief) or (36 1) 213 9793

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2020  
Total Cites 987
WoS
Journal
Impact Factor
0,955
Rank by Veterinary Sciences 101/146 (Q3)
Impact Factor  
Impact Factor 0,920
without
Journal Self Cites
5 Year 1,164
Impact Factor
Journal  0,57
Citation Indicator  
Rank by Journal  Veterinary Sciences 93/166 (Q3)
Citation Indicator   
Citable 49
Items
Total 49
Articles
Total 0
Reviews
Scimago 33
H-index
Scimago 0,395
Journal Rank
Scimago Veterinary (miscellaneous) Q2
Quartile Score  
Scopus 355/217=1,6
Scite Score  
Scopus General Veterinary 73/183 (Q2)
Scite Score Rank  
Scopus 0,565
SNIP  
Days from  145
submission  
to acceptance  
Days from  150
acceptance  
to publication  
Acceptance 19%
Rate

 

2019  
Total Cites
WoS
798
Impact Factor 0,991
Impact Factor
without
Journal Self Cites
0,897
5 Year
Impact Factor
1,092
Immediacy
Index
0,119
Citable
Items
59
Total
Articles
59
Total
Reviews
0
Cited
Half-Life
9,1
Citing
Half-Life
9,2
Eigenfactor
Score
0,00080
Article Influence
Score
0,253
% Articles
in
Citable Items
100,00
Normalized
Eigenfactor
0,09791
Average
IF
Percentile
42,606
Scimago
H-index
32
Scimago
Journal Rank
0,372
Scopus
Scite Score
335/213=1,6
Scopus
Scite Score Rank
General Veterinary 62/178 (Q2)
Scopus
SNIP
0,634
Acceptance
Rate
18%

 

Acta Veterinaria Hungarica
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Acta Veterinaria Hungarica
Language English
Size A4
Year of
Foundation
1951
Publication
Programme
2020 Volume 68
Volumes
per Year
1
Issues
per Year
4
Founder Magyar Tudományos Akadémia
Founder's
Address
H-1051 Budapest, Hungary, Széchenyi István tér 9.
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 0236-6290 (Print)
ISSN 1588-2705 (Online)

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