RT Book, Section
A1 O’Gara, Patrick T.
A1 Loscalzo, Joseph
A2 Jameson, J. Larry
A2 Fauci, Anthony S.
A2 Kasper, Dennis L.
A2 Hauser, Stephen L.
A2 Longo, Dan L.
A2 Loscalzo, Joseph
SR Print(0)
ID 1155973021
T1 Physical Examination of the Cardiovascular System
T2 Harrison's Principles of Internal Medicine, 20e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259644016
LK accesspharmacy.mhmedical.com/content.aspx?aid=1155973021
RD 2024/04/19
AB The  approach  to  a  patient  with  known  or  suspected  cardiovascular  disease  begins  with  the  time-honored  traditions  of  a  directed  history  and  a  targeted  physical  examination.  The  scope  of  these  activities  depends  on  the  clinical  context  at  the  time  of  presentation,  ranging  from  an  elective  ambulatory  follow-up  visit  to  a  more  urgent  emergency  department  encounter.  There  has  been  a  gradual  decline  in  physical  examination  skills  over  the  last  two  decades  at  every  level,  from  student  to  faculty  specialist,  a  development  of  great  concern  to  both  clinicians  and  medical  educators.  Classic  cardiac  findings  are  recognized  by  only  a  minority  of  internal  medicine  and  family  practice  residents.  Despite  popular  perceptions,  clinical  performance  does  not  improve  predictably  as  a  function  of  experience;  instead,  the  acquisition  of  new  examination  skills  may  become  more  difficult  for  a  busy  individual  practitioner.  Less  time  is  now  devoted  to  mentored  cardiovascular  examinations  during  the  training  of  students  and  residents.  One  widely  recognized  outcome  of  these  trends  is  the  progressive  overutilization  of  noninvasive  imaging  studies  to  establish  the  presence  and  severity  of  cardiovascular  disease  even  when  the  examination  findings  imply  a  low  pretest  probability  of  significant  pathology.  Proponents  of  the  use  of  hand-held  ultrasound  devices  to  identify  and  characterize  structural  cardiac  disease  have  called  for  its  incorporation  into  educational  curricula.  Techniques  to  improve  bedside  examination  skills  include  repetition,  patient-centered  teaching  conferences,  visual  display  feedback  of  auscultatory  events  using  Doppler  echocardiographic  imaging  and  simulation-based  training.