When using a non-electronic, cardiology-type stethoscope versus the LittmannA stethoscope 3000 series, cardiologists missed an
S3 gallop 40% more often, a Grade 2 aortic regurgitation murmur five times more often and critical care nurses misidentified whether a sound was normal or abnormal two times more often.
Absence of dyspnea on exertion effectively ruled out the diagnosis (LR- 0.03), while an S3 gallop (LR+ 24.0) and a displaced apex (LR+ 16.5) strongly supported the diagnosis of LVSD.
The clinical features that best ruled-in LVSD were an S3 gallop, a displaced cardiac apex, a history of diabetes mellitus or MI, and JVD.