Rene Theophile Hyacinthe Laennec (1781-1826) with stethoscope
(painting date unknown)

The cardiopulmonary exam is widely regarded as the centerpiece of the comprehensive physical exam. Only through practice and repetition can learners hone their skills in this area to become excellent diagnosticians, however, like other portions of the physical exam, the cardiopulmonary exam can be divided into multiple sections to facilitate ease of learning.

One method we propose for dividing this important organ system is to begin by observing the patient’s appearance (age, body position, facial appearance, chest/abdomen respiration ratio, etc.), followed by attention to vital signs (heart rate, heart rhythm, blood pressure, respiratory rate, pulse oximetry, etc.), inspection of the great veins (jugular venous height, waveform, and respiratory variation), inspection of the great arteries (proximal and distal pulses), palpation of the cardiac apical pulse (size/diameter, location, intensity, etc.) and chest expansion, and finishing with auscultation of important anatomical areas (heart valves, major arteries, lung fields, etc.).

Learners may adapt this approach to their own style of physical examination, however, attention should be made not to skip any of the critical elements listed above.

We have included journal articles organized by individual physical exam skill and cardiopulmonary pathophysiology, as well as instructional videos for refining the cardiopulmonary exam.  

OVERVIEW

Click to Access the Following PDFs:

1:Cardiac physical diagnosis in the digital age: an important but increasingly neglected skill (from stethoscopes to microchips)

2: Initial assessment and treatment with the airway, breathing, circulation, diability, exposure (ABCDE) approach

3: The examination of the heart: the importance of initial screening

4: Why does the heart beat? The discovery of the electrical system of the heart

5: A survey of health care practitioners' knowledge of the QT interval

6: Long-term outcome associated with early repolarization on electrocardiography

AUSCULTATION

Click to Access the Following PDFs:

1: Auscultation of the heart: examination of the heart, part 4

2: Editorial: On the genesis of heart sounds: contributions made by echocardiographic studies

3: Spread of heart sounds over chest wall

4: Current concepts in cardiology: Practical cardiac hemodynamics

5: Tricuspid component of first heart sound

6: Mechanism of normal splitting of the second heart sound

INSPECTION

Click to Access the Following PDFs:

1: Jugular venous pulse: an appraisal

2: How far is the sternal angle from the mid-right atrium?

 

PALPATION

Click to Access the Following PDFs:

1: The cardiac impulse and the motion of the heart

2: The cardiac apex impulse: clinical and angiographic correlations

3: Relationship between quantitiated precordial movement and left ventricular function

4: The left parasternal impulse

5: The clinical significance of systolic retraction of the apical impulse