Audiocardiography in the cardiovascular evaluation of the morbidly obese

Summary Morbid obesity is believed to limit cardiovascular auscultation. We compared audiocardiography to senior attending physicians using conventional stethoscopes in 190 individuals with morbid obesity. Overall, there were 128 (67·4%) women and 62 (32·6%) men with mean ages of 44·9 ± 12·3 and 51·3 ± 10·8 , respectively (P = 0·001). The overall body mass index (BMI) was 47·3 ± 8·5 kg m−2. Of those with an S3 by audiocardiography (n = 7), one had a history of coronary artery disease (CAD), none had a history of heart failure, and one had a left ventricular ejection fraction (LVEF) 5) identified by acoustic cardiography while there were 42 (22·1%) heard by the stethoscope and it was heard with both methods in nine patients (21·4% concordance). There were no significant correlations between BMI or peak oxygen consumption and S3 or S4 strength by audiocardiography. Acoustic cardiography performed with an electronic device was not helpful in assisting the cardiovascular examination of the morbidly obese. These data suggest the careful clinical exam with attention to traditional cardiac auscultation using a stethoscope in a quiet room should remain the gold standard.