Despite the fact that more than half the patients seeking care from an internal medicine specialist or a family physician will have either a primary or secondary cardiac problem, the teaching of cardiac auscultation, the physical examination of the heart, has been deteriorating since the advent of such modern diagnostic tools as 2D echocardiology and nuclear imaging. In The Art and Science of Cardiac Physical Examination veteran academic clinicians bring the art and science of cardiac physical examination to the bedside with a tour de force tutorial on techniques needed to elicit various physical signs and to interpret them in relation to the patient's symptoms and underlying cardiac condition. Drawing on twenty-five years of teaching and training physicians and physicians-to-be, the authors integrate the physiology, pathophysiology, and mechanisms behind the various physical signs with a thorough and easy-to-use practical approach that makes a physician feel more comfortable and competent performing the cardiac physical examination. The authors pay particular attention to the interpretation of the jugular venous pulsations and contour and make the physiology and pathophysiology of the normal and abnormal arterial pulse interesting and relevant. They also clarify the apical impulse and its importance. Local and systemic manifestations relevant to cardiac diagnosis are also emphasized and illustrated. Comprehensive and instructive, The Art and Science of Cardiac Physical Examination provides the student of cardiology with the proper techniques and understanding of the art and science of the cardiac physical examination to develop the skills required of any astute clinician.

Zusammenfassung
It has been our experience that instruction in physical examination of the heart in medical schools has been deteriorating since the advent of such modern diagnostic tools as two-dimensional echocardiography and nuclear imaging. At best, the teaching has been sketchy and too superficial for the student to appreciate the pathophysiological correlates. Both invasive and the noninvasive modern technologies have contributed substantially to our knowledge and understanding of cardiac physical signs and their pathophysiological correlates. However, both students and teachers alike appear to be mesmerized by technological advances to the neglect of the age-old art, as well as the substantial body of science, of cardiac physical examination. It is also sad to see reputed journals give low priority to articles related to the clinical examination. Our experience is substantiated by a nationwide survey of internal medicine and cardiology training programs, which concluded that the teaching and practice of cardiac auscultation received low emphasis, and perhaps other bedside diagnostic skills as well (1). The state of the problem is well reflected in the concerns expressed in previous publications (24), including the 2001 editorial in the American Journal of Medicine (Vol. 110, pp. 233235), entitled Cardiac auscultation and teaching rounds: how can cardiac auscultation be resuscitated?, as well as in the rebuttal, Selections from current literature. Horton hears a Who but no murmursdoes it matter? (5).

Inhalt
Approach to the Physical Examination of the Cardiac Patient.- Arterial Pulse.- Blood Pressure and Its Measurement.- Jugular Venous Pulse.- Precordial Pulsations.- Heart Sounds.- Heart Murmurs.- Heart Murmurs.- Elements of Auscultation.- Pathophysiological Basis of Symptoms and Signs in Cardiac Disease.- Local and Systemic Manifestations of Cardiovascular Disease.