During the initial physical examination the doctor attempts to follow up and confirm any hunches he may have had, at the same time retaining an open mind about the cause of the patient's distress. It is surprising to the lay person to learn how much can be inferred by the physician from this basic external examination. The doctor will first use his senses of sight and touch to search for distended neck veins, swelling in the legs or at the base of the spine and for any abnormal veins that one can see over the stomach. The doctor will 'palpate' the heart so that he can feel the beat - for example, if there is a strong apex beat, this s indicative of an enlarged left ventricle. The doctor can actually feel abnormal sounds and murmurs. The next step is auscultation, where the stethoscope is used to hear more precisely what goes on in the heart in order to detect the characteristic murmurs as the blood flows through malfunctioning heart valves.

As a matter of fact, heart murmurs - extra sounds over and above the regular heartbeat -are much more common than you might think. Often new-born babies have them, although most disappear spontaneously. And not all murmurs indicate heart disease. Many adults have extraneous murmurs, called innocent murmurs, which do not appear to affect the function of the heart at all.

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CARDIO & BLOOD