There was a time when cardiac percussion was considered a useful addition in the clinical evaluation of the patient with heart disease. This skill has been largely lost with the advent of new imaging techniques such as X-ray and echocardiography, both of which are more accurate in defining cardiac size and borders and detecting the presence and extent of pericardial fluid. Area of absolute dullness Areas of absolute dulness in enlarged heart [solid line], and in distended pericardium [dotted line] In the fast-paced world of modern medicine, do cardiologists spend time percussing the chest, trying to sort out if there is cardiomegaly or fluid in the pericardium, when in minutes they could have a more accurate and definitive diagnosis with echocardiography? The honest answer is no. However, cardiac percussion skill as well as knowledge of its implication might provide quick information at the bedside, most especially in significant pericardial effusion, pending confirmation with echocardiography. When used in isolation, cardiac percussion is prone to error but when used in clinical context with other findings, it could still be an invaluable bedside tool in differentiating tamponade from acute massive pulmonary embolism until confirmation with echocardiography. Should its use be encouraged in modern clinical practice? I personally think so, even though the majority of cardiologists may not agree. Cardiac percussion is an art and a science. The practice of medicine is an art and medical students should learn the art of medicine. Likewise, practicing cardiologists should be encouraged to use the technique in their modern clinical practice as it is still helpful in certain cardiac conditions. After all, the ability to practice an art is satisfying in our highly technical world. Source
