The Physiological Origins of Heart Sounds and Murmurs does not require installation. Instead, it runs directly from the CD on both Macintosh and PC platforms. It is an executable built with Authorware, an excellent authoring package. The minimum requirements for the PC are: 486sx, 8 MB RAM, dual‐speed CD‐ROM drive, 256 color SVGA 640x480 resolution, Windows 3.1 or later, sound card and speakers, mouse and keyboard (MPC2 is recommended). The minimum requirements for the Mac are: LC II or better, 8 MB RAM, dual‐speed CD‐ROM drive or better, Mac System 7 or later, mouse and keyboard.
This CD is an example of innovative use of sound combined with animation and morphing to simulate medical phenomenology relevant to the diagnostic process. The product integrates functional anatomy with cardiac auscultation in order to portray the causation of bedside clinical findings. In doing so, it relies heavily on multimedia content which often consists of data recorded with analog devices and later digitized and enhanced or processed.
Multimedia objects range from still images to animation, morphing, animated graphs, sounds, graphic representation of sounds, along with spectroscopic takes etc. , etc. The quality of the sound, image, and video objects is acceptable, as the quality of the analog originals was low. Each of the objects is very effective in carrying the intended information and is appropriate in the context.
The product is complete and very detailed in its focus. The intended audience is the medical student or the professional looking for first hand sensory experience in a context. The product is the result of several years of medical practice and research at the St. John s Cardiovascular Research Institute on the Harbour‐UCLA Campus and of the generosity of patients and doctors who have allowed the sounds and images to be taken. The result is a very useful collection of objects that portray the causation of bedside findings.
The product does not come with a search engine; and this is a major drawback. The complexity of the terminology, along with the number of indexed topics, may become confusing, especially for the neophyte. Perhaps both a hyper‐map and search engine, based on objects metainformation, could improve dramatically the accessibility of the information. Such an addition could prove to be very useful for the next release.
The documentation is meagre. It includes a small introduction that can be opened from the first screen and a short printed flier with a detailed table of contents. The topics addressed in this work are articulated in four general categories:
a) General Tutorials, including inspection and palpation, auscultation, effects of maneuvers and perturbations, hemodynamics, and imaging techniques
b) Timing of Heart Sounds, including valve closure, splitting and opening, third, fourth, ejection, and mid‐systolic sounds. c) Timing of Murmurs, including systolic, diastolic, continuous Vs. to and froy murmurs, and friction rubs.
d) finally, a long and detailed catalog of lesions including normal conditions, valvar lesions, pericardial disease, congenital heart disease, cardiomyopathies, and myxoma. Heart Sounds and Murmurs offers a range of sensorial information that cannot be found in any printed publication. The combination of information is richer than any combination analog media could offer. This work is a good example of the potential of multimedia in medical reference material.
