Physical Examination of the Heart and Circulation

Abstract

The examination of the heart and circulation has a long and rich tradition in clinical medicine. Most of the cardinal signs of cardiovascular disease detectable on the physical examination were described and documented by master physicians during the 19th and early 20th centuries. Subsequently, echocardiography and cardiac catheterization have demonstrated that the presumed pathogenesis of many to most cardiovascular abnormalities on the physical examination were accurately and presciently described before these modern techniques became available. In the past, generations of internists and cardiologists were well trained in the skills of cardiac examination; the absence of our current ultrasound technology providing “immediate” answers contributed to the emphasis of expertise in cardiac physical diagnosis. Unfortunately, clinical skills in this area are no longer emphasized in medical education, in part due to the burgeoning of other aspects of medical science that must be taught in the medical student curriculum. The advent of readily available two-dimensional echocardiography has clearly contributed to the demise of cardiac physical diagnosis capability among physicians, a phenomenon well documented in recent published studies.