Some Thoughts on the Clinical Diagnosis of Heart Disease

In spite of the many advances that have been made in the past two decades in technical procedures designed to aid in the diagnosis of cardiovascular disease, the clinical examination remains the single most reliable method for determining the etiologic, anatomic and hemodynamic diagnosis. It is safe to say that more mistakes in diagnosis are made as a result of inadequate clinical examination than from any other single reason. This method of examination is available to all physicians and the only essential instrument is a stethoscope, although the ophthalmoscope and the sphigmomanometer are sometimes useful. In this age of right and left heart catheters, phonocardiography and vectocardiography, image intensification and cineangiocardiography, the pure cardiac physiologists will probably agree that the plain PA chest X-ray and the ordinary 12 lead electrocardiogram may be considered as part of the clinical examination.