A physical examination, also known simply as a physical, is a process in which the physician examines organ systems and other parts of the patient's body. As the standard tool used to diagnose diseases and monitor health, it represents the cornerstone of preventive medicine. It is far better to prevent a disease than to treat it, and better to treat it early before it worsens.
More specifically, a cardiovascular examination targets the heart and its major vessels. This exam may include a cholesterol test, blood pressure reading, electrocardiogram (EKG) and other testing.
Guidelines from medical associations call for adults to begin cardiovascular screenings starting at age 20 and for high-risk children to have cholesterol tests as early as age 2. Screening people at regular intervals can help physicians detect cerebrovascular disease and cardiovascular disease before the presence of symptoms. Early detection allows for treatment that may prevent a stroke, heart attack or other major health event.
About physical examinations
Also known simply as a "physical," a physical examination is the process by which a physician inspects various organ systems and other parts of the patient's body. It provides the physician the opportunity to look for signs of heart disease or other illnesses. Aside from taking a full medical history, this process is the most important strategy in identifying cardiovascular conditions and other illnesses.
The physician uses a fairly structured process to conduct the exam. In general, a physical includes these four elements:
Inspection. After collecting information through a medical history, the physician will look at various parts of the patient's body, with a focus on any region of complaint.
Palpation. Gently pressing the skin can help the physician identify areas of tenderness or swelling, as well as the size and texture of a growth, organ or other body part. During a cardiac exam, the chest may be palpated to feel for any abnormalities.
Percussion. Most people have had their chest gently tapped by a physician's fingers. This is an example of percussion, tapping on the chest or abdomen to gauge normal or abnormal responses. Different areas of the body elicit different responses, depending on the structures and tissues present. For instance, if you tap on your chest bone, or sternum, the area should sound relatively solid because of the presence of hard bone. Differences in sound are due largely to the amount of fluid in the tissue or body cavity, which can be an important indicator of normal or abnormal functions.
Auscultation. Using a stethoscope, the physician will listen to the heartbeat and other sounds within the body. Normal functions and many abnormal conditions have characteristic sounds that can be identified through this process.
More specifically, the physician may assess the following:
Vital signs
General appearance
Eyes, ears, nose, throat and mouth
Neck, particularly the thyroid gland and cervical lymph nodes
Respiratory, cardiovascular and gastrointestinal systems
Breast examination for women and men
Muscles, joints, bones and skin
Neurological and psychiatric condition
Genitals (including men's prostate gland and testicles and women's pelvic area, though many women instead have their pelvic exam when they see a gynecologist)
There is some question regarding the optimal schedule for physical examinations. In the past, most physicians recommended annual physical exams for all patients. Routine screening tests were also ordered at this time. Some medical groups, however, now recommend that the frequency of routine physical examinations be dependent on the person's age, medical history and other factors that might influence diseases. By targeting patient groups specifically, it may be more logical to include relatively costly screening tests in some populations and forgo tests in other populations. Patients are advised to consult their primary care physician about the timing of physical examinations and what the exams should include.
About cardiovascular examinations
A cardiovascular exam is far more focused on the condition and function of the heart and blood vessels than a general physical examination. It concentrates on the function and performance of the heart, veins and arteries.
The recommended schedule of screening tests from the American Heart Association (AHA), starting at age 20 unless otherwise indicated:
Blood pressure. Reading taken at each healthcare visit, or at least once every two years if it is less than 120/80 millimeters of mercury (mm Hg).
Cholesterol. Blood testing (lipid profile) performed every five years for normal-risk people, more often for higher-risk people, including men older than 45 and women older than 50.
Glucose. Blood sugar test performed every three years starting at age 45.
Waist circumference. Measured as needed to help evaluate cardiovascular risk.
Weight. Noted at each healthcare visit.
Physicians may offer a different schedule of screening tests tailored to a patient's needs. For example, people with risk factors such as obesity or family history of diabetes may receive glucose tests more often and starting at a younger age.
Depending on the case, a cardiovascular exam may also include other tests, such as an electrocardiogram (EKG), an echocardiogram, a coagulation blood test or a stress test.
If a patient's cardiovascular risk factors increase, physicians may prescribe interventions such as weight loss, exercise and medication. They may request more frequent cardiovascular exams to make sure therapy is working.
For children, the American Academy of Pediatrics recommends that high-risk patients, such as those with a family history of heart disease or high cholesterol, begin cholesterol screening tests as early as age 2 and start no later than age 10.
About auscultation
Auscultation is the process of listening to the internal sounds of the body to assess for any underlying disease. Physicians use this method to evaluate the frequency, intensity, duration, number and quality of various internal sounds. It is used in both routine medical examinations and in diagnosing specific conditions. Auscultation is performed through the use of a stethoscope, which allows a physician to listen to the heart as it contracts and relaxes.
The normal "lub-dub" sound of the heart made during the "one-two" sound of the heart is made during the two stages of a heartbeat:
The first stage (systole) makes a sound as the two valves between the upper chambers (the atria) and the lower chambers (the ventricles) close. The valve between the left atrium and the left ventricle is called the mitral valve, and the valve between the right atrium and the right ventricle is called the tricuspid valve. The closed valves keep blood from leaking prematurely from the upper chambers to the lower chambers of the heart.
The second stage (diastole) makes a sound as the other two valves of the heart close. One valve is the aortic valve between the left ventricle and the aorta, and the other valve is the pulmonic valve between the right ventricle and the pulmonary artery. The closed valves keep blood from leaking back into the left and right ventricles, respectively.
Abnormal sounds may be heard through the process of auscultation. For example, the physician may hear clicks, whooshes, snaps or other sounds that characterize a heart murmur. A heart murmur may be a sign of valvular heart disease, or it may be "innocent," with no underlying disease. The physician may also hear abnormal heart rhythms (arrhythmias).
In evaluating the cardiovascular system, a physician will also listen to the lungs, checking for any abnormal breath sounds, such as shallow breathing, wheezing and crackling. These and other abnormal sounds could indicate conditions such as reduced airflow to the lungs, overinflation of a portion of the lungs, or air or fluid in the lungs. They could also indicate conditions such as asthma, emphysema, bronchitis and pulmonary edema (swelling).
A blood pressure reading can be taken with a stethoscope and a blood pressure cuff (sphygmomanometer) that is wrapped around the patient's arm. The physician can also place the stethoscope directly over an artery to listen to the sound of the blood flow. For example, he or she may hear a turbulent, rough sound, called a bruit, which could be a sign of obstruction within the vessel. When heard in the carotid artery in the neck, it is known as a carotid bruit and is seen as a risk factor for stroke.
Ideally, the physician places the stethoscope on the patient's bare skin for the clearest sounds. The patient may also need to move around or take deep breaths in order to obtain the best sounds.
Role in preventing heart disease
A regular schedule of general and cardiovascular examinations may help prevent some conditions from occurring and detect the early onset of others. However, because many factors play a role in the development of heart disease, it may not be possible to completely hold cardiovascular problems at bay.
As vital as routine examinations are for good heart health, it is also important to be attentive to any possible symptoms that may arise and to seek medical attention promptly. Heart disease, high blood pressure and diabetes are just a few of the conditions that can be detected and managed before they become life threatening.
Although physical and cardiovascular examinations should become a regular part of an adult's wellness program, many people do not see a physician regularly. Statistically, women are more likely to get regular checkups than men. This may partly be because women typically make their gynecologic exam a regular part of their health maintenance, providing an opportunity for a health professional to catch a problem or potential problem early.
In addition, government agencies and corporate sponsors often promote women's health care but not men's. For example, the American Heart Association and other organizations tout a highly publicized "Go Red for Women" cardiac-health program but nothing comparable for men.
Studies have found that men typically seek medical attention when something "feels" wrong. This can be problematic, as men remain at a higher risk than premenopausal women for developing heart disease, the leading cause of death in the United States.
Questions for your doctor
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about cardiovascular examinations:
How often should I have a cardiovascular exam, and starting at what age?
What should my cardiovascular exam include?
Can my primary doctor perform my cardiovascular exam as part of a physical, or should I see a cardiologist?
What else should my physical exam cover, and how often should I have a general physical?
What will be your focus during my exam?
What can the exam tell you about my heart and blood vessels?
Will you be performing any blood tests or other tests?
Do I need to fast, bring in a list of medications or do anything else to prepare for my exam?
How can exams help me to prevent heart disease and other diseases?
What symptoms indicate the need for more frequent examinations?
