We have gone through the orderly bedside examination with five parts or five fingers, if you will - the general appearance of the patient, normal. Then we assessed the arterial pulse in terms of the blood pressure, normal; heart rate and rhythm, normal; arterial pulses, both central and peripheral, normal in upstroke, peak and downstroke. Oh, by the way, a little pearl about assessing normal - feel your own arterial pulse, you get a good baseline. Then we looked at the venous pulse. We assessed two things: central venous pressure using this marker on the chest - the sternal angle, and the wave form. Oh, by the way, another pearl, a little tangential light will bring out those neck veins so nice, and you will be able to see the wave - both the "a" wave and the "v", wave quite normal. Chest wall movement - again normal in our patient, 5th interspace, midclavicular line, a little early systolic tap... Just a light tap, not sustained, not displaced. Sometimes, by the way, acoustic events are either so intense or of such a frequency, you can actually feel them on the chest wall. And finally, we listened to the patient, upper right sternal edge... "lub dub, lub dub", very clearly the beginning and the end of systole. Upper left sternal edge... "lub didup, lub didup, lub didup", .06 seconds inspiratory, normal splitting of the second heart sound. Lower left sternal edge... "didp dub, didp dub, didp dub", .03 seconds first heart sound splitting. And finally, at the apex, the proper use of the bell of the stethoscope - light pressure... "lub dub boom, lub dub boom, lub dub boom". You're hearing pathophysiology and, in this case, normal physiology with blood rushing into the ventricle in early diastole, accelerating and then decelerating.

Finally, let’s just think about what this bedside examination does for you and for the patient. Well, to begin with, it makes you think about pathophysiology and normal physiology. It makes you think about blood flow, the arterial pressure curves. It makes you think about the valves closing and opening. In addition, it helps you so much to evaluate data that seems to be so hard and so fixed, such as echocardiograms, and electrocardiograms, and angiographic data. You can put it in perspective. And last, but really not least, it brings you that much closer to the patient, that laying on of hands, and will just help to establish that type of relationship that will most optimally help you to care for your patient properly, engender their confidence in you, so the proper diagnosis and care is very complete.