Cardiac Physical Diagnosis in the Digital Age: An Important but Increasingly Neglected Skill (from Stethoscopes to Microchips)

With the advent of readily available imaging modalities, the time-honored skills in physical examination of the cardiac patient have eroded and are no longer the hallmark of the expert cardiologist. Although auscultation continues to be the primary focus in the examination, this is a skill in which competency is only achieved through continuous exposure, and does not quantitate the physiologic status of the patient. Accuracy in the examination is best achieved by evaluating the physiologic variables that characterize cardiac function (pulse amplitude, blood pressure, jugular venous pressure, and makers of neurohumoral activation), and the identification of which cardiac chambers are involved using precordial motion and the electrocardiogram. Practical methods for the acquisition of these clinical observations are discussed. These clinical data are often more quantitative and easier to acquire for many clinicians than is proficiency in auscultation, and facilitate accurate diagnosis of cardiac conditions including murmur interpretation. In conclusion, even in the digital age, the physical examination remains uniquely relevant to patient care, particularly when focused on the physiologic status of the cardiac patent.