MurmurQuiz is designed to help students of cardiac auscultation learn by listening to actual cases. You will be able to listen to heart sounds then answer 4 basic questions about each case: 1) is the case likely normal, normal with innocent murmur, or abnormal, 2) if abnormal, what findings are abnormal, 3) what specific description of the findings is most likely, and 4) what specific set of diagnoses is most likely. The “Practice” section is designed to help you with each of these aspects of auscultation. You will be scored on each of these questions and will thus be able to follow your progress as you improve in each area. Check the “Score” section to see how you are doing with the practice cases. We believe competent auscultation involves accurate listening, understanding of the key findings, and correct association of those key findings with a likely diagnosis. This module does not include any patient history, as we want the learner to focus on listening without other cues. However, auscultation is practiced in reality as part of a complete evaluation which includes taking a good history and performing a complete examination, all of which goes into forming a diagnosis. The “Screening test” section presents 20 cases in random order for you to screen for heart disease using only auscultation. You will only be trying to decide whether the patient has heart disease or not, which is the most important use of auscultation for many health care providers. Your score on this screening test is separate from your Practice scores. You can take this test as often as you like to see how your screening skills are improving. We provide a case search feature in the “Learn” section to allow the user to find cases using clinical keywords. Each case includes clinical history along with the sounds. These cases can be collected by the user for further study and will be located in the “Collected Cases” section. There are also helpful additional “Learning materials” in this section. Teachers of auscultation can request an additional level of access to the site to be able to create learning sets of the cases and custom quizzes that can also include history elements to use with their trainees (please contact us for further details). The “Quizzes” section is for custom quizzes that are created by your teacher specifically for you.
MurmurQuiz uses cases from the Cardiac Auscultatory Recording Database (CARD), found in our website https://murmurlab.com. In July 1997, we began recording and storing digitized heart sounds and clinical data on patients having an echocardiogram done in the Pediatric Cardiology Echocardiography Laboratory at the Johns Hopkins Hospital. To date we have collected over 5000 individual recordings from over 1000 cardiology clinic visits by more than 900 different patients. The primary data files have been post processed into over 100,000 related sound files of 20 seconds duration each, in three different formats. An additional ~14,000 related image files depicting phonocardiograms, spectrograms, and 12-lead electrocardiograms from this patient population has also been collected in the database. Patients range in age from 1 day old to 80 years. Approximately 25% of the patients have no detectable heart disease by echocardiogram, with roughly 25% of these "normals" having at least one "innocent" heart murmur. Among the other patients with an abnormal echocardiogram, a wide range of diagnoses is represented, including these common congenital lesions: tetralogy of Fallot, atrial septal defects, common atrio-ventricular canal, mitral regurgitation, ventricular septal defects, coarctation of the aorta, bicuspid aortic valve, aortic stenosis, aortic regurgitation, mitral stenosis, mitral valve prolapse, pulmonary stenosis, idiopathic hypertrophic subaortic stenosis, patent ductus arteriosus.
We want to thank Nancy Riess and the Department of Pediatrics, Johns Hopkins University School of Medicine, for encouragement and generous support of this project. We especially thank Travis Poulsen, of the Johns Hopkins Medicine Technology Innovation Center, for the original design and engineering of the site, with help from Gorkem Sevinc, Michael Cohen, Julia Brown, and Paul Nagy. We thank Edwin Choi for original artwork. We gratefully acknowledge the additional work on version 2.0 by Kyle Hasty with input from Andy Dam, Katie Patras, Jasmine McNeil, and Patrick Ostendarp. We also acknowledge these colleagues who have provided many helpful comments: Janet Serwint, Michael Barone, Katherine Press, Bob Dudas, and Daniel Mauriello.