Present role of the precordial examination in patient care

Recent observations suggest that many physicians do not consider the bedside cardiac examination as a valuable tool in patient care. Internists, hospitalists, emergency department physicians, cardiologists, physician assistants, and nurse practitioners were interviewed to ascertain their current practice in completing the cardiac examination. In addition, we surveyed patients in a cardiology practice concerning their attitudes about the cardiac physical examination. The study found that a significant number of practitioners failed to carry out a basic cardiac examination. Most patients do not have their chest exposed. It is unusual for the patient to be examined in the lateral decubitus position or for maneuvers to be used to evaluate the significance of a murmur. Most patients were more confident in the physician when a bedside examination was carried out, and they expect to undress for the examination. Half of the patients were more secure when they were undressed if there was a attendant of the same gender in the room. Review of the medical literature suggests that when a skilled examiner completes the bedside cardiac examination, it has an excellent sensitivity and specificity to recognize clinically significant cardiac disorders. A thorough cardiac bedside examination can make an echocardiogram unnecessary in some patients and compliment the echo in every patient. In conclusion, the bedside cardiac examination is a valuable diagnostic aid for diagnosing heart disease. If on the teaching wards and in the medical journals more emphasis is placed on the importance of physical findings for diagnosing heart disease, more physicians will make the effort to perform a thorough examination.