Phonocardiography: Revival of Cardiac Auscultation in the Digital Era

Cardiac auscultation remains a fundamental component of bedside cardiovascular examination. However, traditional auscultation using an acoustic stethoscope is highly dependent on clinician expertise and subjective interpretation. Phonocardiography (PCG), the graphical recording of heart sounds and murmurs, provides an objective method for analyzing cardiac acoustic signals. With the emergence of digital stethoscopes, advanced signal processing, and artificial intelligence (AI)–based sound analysis, PCG has significantly regained attention as a diagnostic adjunct in contemporary cardiology.

Recent studies have demonstrated promising diagnostic performance of PCG-based algorithms, with reported sensitivities ranging from 80–92% and specificities of 75–90% for detecting pathological heart murmurs and certain valvular heart diseases. While echocardiography remains the gold standard for structural cardiac evaluation, PCG offers advantages in screening, documentation, and remote monitoring, particularly in primary care and resource-limited settings.

This review discusses the principles of phonocardiography, current clinical applications, diagnostic performance, integration with artificial intelligence, and its potential role alongside echocardiography in modern clinical practice.