During the last centuries, cardiologists were taught to perform physical examination by using their senses; indeed, most clinical diagnoses are still based on auscultation which requires the best skill to recognise abnormal sounds and different types of heart murmurs. However, awareness that abnormal physical findings are not always specific nor always sensitive has led to the development of an armamentarium of diagnostic procedures during the last few decades. In particular, ultrasound imaging allows the cardiac structures to be viewed dynamically, undoubtedly providing a new window on the heart. Currently, echocardiography is the most widely used and cost effective diagnostic imaging tool in cardiology and has largely replaced other imaging modalities in a wide variety of health care environments. Generally, a standard echocardiogram is requested whenever the physical examination is inconclusive or doubtful, or for evaluation of the severity of a known disease.
However, echocardiography is becoming more and more complex and the significant equipment costs, standardised examinations, and required specialised personnel make standard echocardiography time consuming and expensive. The same factors limit access to echocardiography and create delays in getting important results to the bedside. Furthermore, it is generally assumed that to perform any echocardiographic examination an examiner must be completely trained, certified, and examined. However, for answering simple questions, it may not be necessary to go to these extremes.