PE: Heart & Lungs

Advanced assessment of the cardiovascular and respiratory systems requires skill and competence. The listed resources are not comprehensive; however, are intended to provide resources to guide assessment considerations and diagnostic decision-making. 

RESOURCES for CV Assessment

  • 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. (2019). Journal of the American College of ­Cardiology, 74(10), e177–e232. doi:10.1016/j.jacc.2019.03.010
  • AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR (2021) guideline for the evaluation and diagnosis of chest pain: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 78(22), e187–e285.
  • AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA (2018) guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 73(24), e285–e350. https://doi.org/10.1016/j.jacc.2018.11.003
  • American College of Cardiology. (2021). Five things physicians and patients should question. Retrieved from http://www.choosingwisely.org/societies/american-college-of-cardiology
  • American Society of Nuclear Cardiology. (2012). Five things physicians and patients should question. Retrieved from http://www.choosingwisely.org/societies/american-society-of-nuclear-cardiology
  • Chua Chicao, J. M., Parikh, N. I., & Fergusson, D. J. (2013). The jugular venous pressure revisited.   Cleveland Clinical Journal of Medicine, 80(10), 638–644. doi:10.3949/ccjm.80a13039
  • Conn, R. D., & O’Keefe, J. H. (2012). Simplified evaluation of the jugular venous pressure: Significance of inspiratory ­collapse of jugular veins. Missouri Medicine, 109(2), 150–152. Retrieved from http://www.omagdigital.com/publication/?i=108895#{%22issue_id%22:108895,%22page%22:0}
  • Devine, P.J., Sullenberger, L.E., Bellini, D.A., & Atwood, E.J. (2007). Jugular venous pulse : Window into the right heart. Southern Medical Journal, 100(10), 1022–1027. https://doi.org/10.1097/SMJ.0b013e318073c89c
  • Dosh. (2004). Diagnosis of heart failure in adults. American Family Physician, 70(11), 2145–2152.
  • Ducas, J., Magder, S., & McGregor, M. (1983). Validity of the hepatojugular reflux as a clinical test for congestive heart failure. The American Journal of Cardiology, 52(10), 1299–1303. https://doi.org/10.1016/0002-9149(83)90592-1
  • Elder, A., Japp, A., & Verghese, A. (2016). How valuable is physical examination of the cardio-vascular system? ­British Medical Journal, 354, i3309. doi:10.1136/bmji3309
  • Gardezi, S. K., Myerson, S. G., Chambers, J., Coffey, S., d’Arcy, J., Hobbs, R., . . . Prendergast, B. D. (2018). Cardiac auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients. Heart, 104(22), 1832–1835. doi:10.1136/heartjnl-2018-313082
  • Heckerling, P. S., Weiner, S. L., Wolfkiel, C. J., Kushner, M. S., Dodin, E. M., Jelnin, V., . . . Chomka, E. V. (1993). Accuracy and reproducibility of precordial percussion and palpation for detecting increased left ventricular end-diastolic volume and mass. Journal of the American Medical Association, 270(16), 1943–1948. doi:10.1001/jama.1993.03510160061030
  • King, M., Kingery, J., & Casey, B. (2012). Diagnosis and evaluation of heart failure. American Family  Physician, 85(12), 1161–116.
  • Lefort, B., Cheyssac, E., Soulé, N., Poinsot, J., Vaillant, M. C., Nassimi, A., & Chantepie, A. (2017). Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children. Annals of family medicine, 15(6), 523–528. https://doi.org/10.1370/afm.2105
  • Miranda, W. R., & Nishimura, R. A. (2017). The history, physical examination, and cardiac auscultation. In V. Fuster, R. Harrington, J. Narula, & Z. Eapen (Eds.), Hurst’s the heart (14th ed., Chapter 11). New York, NY: McGraw-Hill Education. Retrieved from https://accessmedicine.mhmedical.com/book.aspx?bookID=2046
  • O’Gara, P. T., & Loscalzo, J. (2022). Physical examination of the cardiovascular system. In Loscalzo, J. Facui, A., Kasper, D., Hauser, S., Longo, D., & Jameson, J. (Eds.), Harrison’s principles of internal medicine (21st ed., Chapter 239). McGraw-Hill. Retrieved from https://accessmedicine-mhmedical-com.ezproxy1.library.arizona.edu/content.aspx?bookid=3095&sectionid=265436939
  • Omar, H. & Guglin, M. (2017). Clinical and prognostic significance of positive hepatojugular reflux on discharge in acute heart failure: Insights from the ESCAPE trial. BioMed Research International,  https://doi.org/10.1155/2017/5734749
  • Patarroyo-Aponte, M., & Colvin-Adams, M. (2014). Evaluation of patients with heart failure. Cardiology Clinics, 32(1), 47-62. https://doi.org/10.1016/j.ccl.2013.09.014
  • Roldan, C. A., Shively, B. K., & Crawford, M. H. (1996). Value of the cardiovascular physical examination for detecting valvular heart disease in asymptomatic subjects. The American journal of cardiology, 77(15), 1327–1331. https://doi.org/10.1016/s0002-9149(96)00200-7
  • Seitz, M. P., Minhas, S., Khouzam, A., Khouzam, N., & Harper, Y. (2021). The face is the mirror of the soul. The cardiovascular physical exam is not yet dead!. Current problems in cardiology, 46(3), 100644. https://doi.org/10.1016/j.cpcardiol.2020.100644
  • Shellenberger, R. A., Balakrishnan, B., Avula, S., Ebel, A., & Shaik, S. (2017). Diagnostic value of the physical examination in patients with dyspnea. Cleveland Clinic Journal of Medicine, 84(12), 943–950. https://doi.org/10.3949/ccjm.84a.16127
  • Sinsalo, J., Rapola, J., Rossinen, J., & Kupari, M. (2007). Simplifying the estimation of jugular venous pressure. American Journal of Cardiology, 100(12), 1779–1781. doi:10.1016/j.amjcard.2007.07.030
  • U.S. Preventive Services Task Force. (2018a). Final recommendation statement: Cardiovascular disease: Risk assessment with nontraditional risk factors. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cardiovascular-disease-screening-using-nontraditional-risk-assessment
  • U.S. Preventive Services Task Force. (2018b). Final update summary: Cardiovascular disease risk: Screening with electrocardiography. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cardiovascular-disease-risk-screening-with-electrocardiography
  • Vinayak, A. G., Levitt, J., Gehlbach, B., Pohlman, A. S., Hall, J. B., & Kress, J. P. (2006). Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients. Archives of Internal ­Medicine, 166(19), 2132–2137. doi:10.1001/archinte.166.19.2132

RESOURCES for RESPIRATORY ASSESSMENT

  • Amalakanti, S., & Pentakota, M. R. (2016). Pulse oximetry overestimates oxygen saturation in COPD. Respiratory Care, 61, 423–427. doi:10.4187/respcare.04435
  • Bhatt, S. P., Kim, Y. Il, Harrington, K. F., Hokanson, J. E., Lutz, S. M., Cho, M. H., … Bailey, W. C. (2018). Smoking duration alone provides stronger risk estimates of chronic obstructive pulmonary disease than pack-years. Thorax, 73, 414–421. doi:10.1136/thoraxjnl-2017-210722
  • Bonner, S. N., & Wakeam, E. (2022). The End of Race Correction in Spirometry for Pulmonary Function Testing and Surgical Implications. Annals of surgery, 276(1), e3–e5. https://doi.org/10.1097/SLA.0000000000005431
  • Bordoni, B., Marelli, F., Morabito, B., & Sacconi, B. (2016). Manual evaluation of the diaphragm muscle. International journal of chronic obstructive pulmonary disease, 11, 1949–1956. https://doi.org/10.2147/COPD.S111634
  • Cao, A. M. Y., Choy, J. P., Mohanakrishnan L. N., Bain, R. F., & van Driel, M. L. (2013). Chest radiographs for acute lower respiratory tract infections. Cochrane Database of Systematic Reviews, (12), CD009119. doi:10.1002/14651858 .CD009119.pub2
  • Diehr, P., Wood, R. W., Bushyhead, J., Krueger, L., Wolcott, B., & Tompkins, R. K. (1984). Prediction of pneumonia in outpatients with acute cough-A statistical approach. Journal of Chronic Diseases. https://doi.org/10.1016/0021-9681(84)90149-8
  • Gennis, P., Gallagher, J., Falvo, C., Baker, S., & Than, W. (1989). Clinical criteria for the detection of pneumonia in adults: Guidelines for ordering chest roentgenograms in the emergency department. Journal of Emergency Medicine. https://doi.org/10.1016/0736-4679(89)90358-2
  • Global Initiative for Asthma. (2018). Global strategy for asthma management and prevention. Retrieved from https://ginasthma.org/wp-content/uploads/2018/04/ wms-GINA-2018-report-V1.3-002.pdf
  • Global Initiative for Asthma. (2019). Pocket guide for asthma management and prevention (for adults and children older than 5 years): A pocket guide for health professionals. Retrieved from https://ginasthma.org/wp-content/ uploads/2019/04/GINA-2019-main-Pocket-Guide-wms.pdf
  • The Global Initiative for Chronic Obstructive Lung Disease. (2019). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2019 report. Retrieved from https://goldcopd.org/wp-content/ uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018 -WMS.pdf
  • Heckerling, P. S., Tape, T. G., Wigton, R. S., Hissong, K. K., Leikin, J. B., Ornato, J. P., Cameron, J. L., & Racht, E. M. (1990). Clinical prediction rule for pulmonary infiltrates. Annals of Internal Medicine. https://doi.org/10.7326/0003-4819-113-9-664
  • Holleman, D. R., & Simel, D. L. (1995). Does the clinical examination predict airflow limitation? The Journal of the American Medical Association, 273(4), 313–319. doi:10.1001/jama.1995.03520280059041
  • Holleman, D. R., & Simel, D. L. (1997). Quantitative assessments from the clinical examination: How should clinicians integrate the numerous results? Journal of General Internal Medicine, 12(3), 165–171. doi:10.1046/j.1525-1497.1997.012003165.x
  • Manser, R., Lethaby, A., Irving, L. B., Stone, C., Byrnes, G., Abramson, M. J., & Campbell, D. (2013). Screening for lung cancer. Cochrane Database of Systematic Reviews, (6), CD001991. doi:10.1002/14651858.CD001991.pub3
  • Mazzone, P. J., Silvestri, G. A., Souter, L. H., Caverly, T. J., Kanne, J. P., Katki, H. A., Wiener, R. S., & Detterbeck, F. C. (2021). Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest, 160(5), e427–e494. https://doi.org/10.1016/j.chest.2021.06.063
  • Melbye, H., Straume, B., Aasebøs, U., & Dale, K. (1992). Diagnosis of pneumonia in adults in general practice relative importance of typical symptoms and abnormal chest signs evaluated against a radiographic reference standard. Scandinavian Journal of Primary Health Care. https://doi.org/10.3109/02813439209014066
  • Okunlola, O. E., Lipnick, M. S., Batchelder, P. B., Bernstein, M., Feiner, J. R., & Bickler, P. E. (2022). Pulse Oximeter Performance, Racial Inequity, and the Work Ahead. Respiratory care, 67(2), 252–257. https://doi.org/10.4187/respcare.09795
  • Qaseem, A., Dallas, P., Owens, D. K., Starkey, M., Holty, J. E. C., & Shekelle, P. (2014). Diagnosis of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 161, 210–220. doi:10.7326/M12-3187
  • US Preventive Services Task Force, Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Kubik, M., Landefeld, C. S., Li, L., Ogedegbe, G., Owens, D. K., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C. W., & Wong, J. B. (2021). Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA, 325(10), 962–970. https://doi.org/10.1001/jama.2021.1117
  • Waterer, G. W., Wan, J. Y., Kritchevsky, S. B., Wunderink, R. G., Satterfield, S., Bauer, D. C., … Crapo, R. O. (2001). Airflow limitation is under recognized in well-functioning older people. Journal of the American Geriatrics Society, 49(8), 1032–1038. doi:10.1046/j.1532-5415.2001.49205.x