The stethoscope has been a mainstay of the clincian’s toolkit since the late nineteenth century. In recent years, however, many digital health enthusiasts an even some clinicians have made some pretty dramatic statements about how the stethoscope is soon to be relegated to museums and history books thanks, in large part, to portable ultrasound devices.
A company based in Berkley is taking a different approach, with a device that aims to augment the traditional stethoscope and bring it into the 21st centry.
Eko Devices has developed a Bluetooth-enabled attachment for your stethoscope that captures high quality recordings of auscultated heart sounds. These sounds are then transferred automatically to the cloud, via a connected smartphone or tablet, where the acoustic pattern is compared to a library of over 30,000 heart sounds to identify the most likely cause of an abnormality. On the connected mobile device, the user can both re-listen to the heart sounds and also review the acoustic signal.
There are a number of interesting applications of the device. With an increasing focus on appropriate utilization of echocardiography, there is certainly potential to help primary care physicians identify benign heart sounds and avoid unnecessary imaging or specialty evaluation. Similarly, in the preoperative clinic, it could help augment the detection of serious valvular abnormalities that should warrant evaluation before the patient gets to the operating room.
And for valvular disease that is monitored over time, there could be interesting applications for following disease progression. For example, aortic stenosis has a well-described progression of murmur timing in the cardiac cycle and obscuring of the second heart sound in more severe stenosis. It would be very interesting to see if that could be monitored with simple auscultation, though that would be complicated by undetected changes in systolic function or the development of, say, concomitant mitral regurgitation.
There are also applications in medical training as well, both in the recording of pathologic heart sounds for educational purposes as well as near real-time feedback to training clinicians on their assessment of the heart sounds. Similarly, the latter use could have application in telemedicine; consider for example enabling a remotely located primary care physician to obtain a second opinion on a heart murmur before having their patient drive a hundred miles for an echocardiogram.
Most of these applications are speculative at this point. The device has yet to receive FDA clearance, though that is reportedly expected in the next year or so. It’ll certainly be interesting to see whether the innovative approach taken here saves the venerated stethoscope from the history books.
