16. The heart

This chapter describes the physical examination of the heart. In order to understand the significance of cardiac examination we need a knowledge of the anatomy and physiology of the heart. The examination is divided into a standard examination and examination on indication. The standard examination comprises the inspection, palpation and auscultation of the heart. Examination on indication comprises additional palpation (quality of apex beat and thrills), percussion, additional auscultation (using the diaphragm or bell of the stethoscope in different positions) and assessment of central venous pressure. The section on the clinical significance of cardiac examination includes information on cardiac disorders that produce abnormal findings from physical examination. The following cardiac disorders are discussed: heart failure, myocardial infarction and ischaemia, heart valve defects, congenital heart defects and pulmonary hypertension, pericardial disease, arrhythmia (extrasystoles, atrial fibrillation, atrial flutter, atrioventricular nodal reentry tachycardia (AVNRT), atrial tachycardia) and conduction disorders (AV block and right and left bundle fascicular block).