Clinical significance

The stethoscope is used for auscultation of the heart, and is one of the most iconic symbols for
medicine. Auscultation of heart sounds is done in order to diagnose a number of diseases primarily by listening for heart murmurs.

Atherosclerosis is a condition affecting the cardiovascular system. If atherosclerosis occurs in the

coronary arteries (which supply the heart) the result may be angina pectoris, or in worse cases a
heart attack.

Auscultation of the chest area is a very useful diagnostic tool because of its noninvasiveness.
Heart murmurs in this 3-year old girl revealed a tumorous mass in the right ventricle of the heart,
in this case a cardiac rhabdomyoma.
Being such a complex organ the heart is prone to several cardiovascular diseases some
becoming more prevalent with ageing.[36] Heart disease is a major cause of death, accounting for
an average of 30% of all deaths in 2008, globally.[9] This rate varies from a lower 28% to a high
40% in high-income countries.[10]
Coronary artery disease is also known as ischemic heart disease (IHD), and more usually as
atherosclerosis. This disease is caused by a build-up of plaque along the inner walls of the
arteries which has the effect of narrowing the arteries and so reducing the blood flow to the heart.
It is the most common form of heart disease, the cause of heart attacks and the most common

cause of death, globally.[37] Coronary artery bypass surgery to improve the blood supply to the
heart is often the only treatment option.
Cardiomyopathy is a noticeable deterioration of the heart muscle's ability to contract, which can
lead to heart failure. The most common form of cardiomyopathy is dilated cardiomyopathy.[38]
[39]

Heart failure which can also be congestive heart failure, happens when the heart is pumping
insufficiently and cannot meet the need of blood flow required by the body.[40] Because the heart
is a double pump, each side can fail independently of the other, resulting in heart failure of the
right heart or heart failure of the left heart either of which through causing strain in the other side
can result in the failure of the whole heart. Congestive heart failure results in blood backing up in
the systemic circulation. Edema (swelling) of the feet, ankles and fingers is the most noticeable
symptom. Pulmonary congestion results from left heart failure. The right side of the heart
continues to propel blood to the lungs, but the left side is unable to pump the returning blood into
the systemic circulation. As blood vessels within the lungs become swollen with blood, the
pressure within them increases, and fluid leaks from the circulation into the lung tissue, causing
pulmonary edema. If untreated, the person will suffocate because they are drowning in their own
blood.[41] Common causes of heart failure are a heart attack, valvular heart disease and
hypertension.
Other conditions can interfere with the regular conduction of impulses across the heart. Damage
to the sinoatrial node (SA), (the pace maker of the heart), can result in a slower heart rate.
Ischemia, or an inadequate blood supply to the heart muscle, may lead to fibrillation - a rapid,
uncoordinated shuddering of the heart muscle, a major cause of fatal heart attacks.[41]
Heart murmurs are abnormal or unusual heart sounds which can be caused by an obstruction in
the blood flow. These murmurs can be heard with a stethoscope. Heart murmurs are common in
young children and the elderly even if they have perfectly healthy hearts. They may have heart
murmurs because their heart walls are thin and vibrate with the rushing blood. However,
murmurs in patients who do not fall into either of those categories most often have a valve issue.
For example, if a valve does not close tightly enough, a swishing sound will be heard after that
valve has (supposedly) closed, as the blood flows back through the partially open valve. Distinct
sounds also can be heard when blood flows turbulently through stenosed (narrowed) valves.[41]
Cardiac tamponade, also known as pericardial tamponade, is the condition of an abnormal
build-up of fluid in the pericardium which can adversely affect the function of the heart. The
fluid can be removed from the pericardial sac using a syringe in a procedure called
pericardiocentesis.
Cardiac arrest is the sudden cessation of normal heart rhythm which can include a number of
pathologies such as cardiac dysrhythmia, an irregular and ineffective heart rhythm which can be
either an extremely rapid heart beat (tachycardia) or a very slow one (brachycardia), which
prevents the heart from effectively pumping blood, and asystole, which is the cessation of heart
rhythm entirely.

Exercise results in the addition of protein myofilaments and this can result in hypertrophy where
the size of individual cells are increased but not their number.[7] This is a condition known as
athletic heart syndrome. The hearts of athletes can pump more efficiently at lower heart rates.
However, enlarged hearts can have a pathological cause which can result in a