[Physical examination of the heart]

Although almost every doctor daily carries out physical examination of the heart, there is little reliable research into the value of the conclusions. Inspection and palpation of the apex beat and percussion of the left heart border are important in diagnosing enlargement of the heart. If the dullness falls within the mid-clavicular line, cardiac enlargement is almost certainly excluded. The presence of an abnormal heart murmur indicates a high probability of a haemodynamically significant ventricular septal defect or valve deficiency. The absence of a murmur definitely does not exclude a serious valve deficiency. In case of abnormal heart sounds, such as irregular rhythms, splitting of heart sounds or extra sounds, further investigations are always necessary to determine the clinical importance.