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Evaluation of the patient with known or suspected cardiovascular dis- ease begins with a directed history and targeted physical examination, the scope and duration of which depend on the clinical context of the patient encounter. Elective, ambulatory investigations allow compara- tively more time for the development of a comprehensive assessment, whereas emergency department visits and urgent bedside consulta- tions necessitate a more focused strategy. The elicitation of the history, with its emphasis on major cardiovascular symptoms and their change over time, demands a direct interaction between the clinician and patient, and should not be delegated to another nor inferred from infor- mation gleaned from a cursory chart review. The history also affords a unique opportunity to assess the patient’s personal attitudes, intel- ligence, comprehension, acceptance or denial, motivation, fear, and prejudices. Such insights allow a more informed understanding of the patient’s preferences and values regarding shared decision making. The interview also can reveal genetic or familial influences and the impact of other medical conditions on the manifesting illness. Although time constraints have limited the emphasis on careful history taking, the information gathered from the patient interview remains essential to inform the design of an efficient diagnostic and treatment plan. Physical examination skills have declined. Only a minority of inter- nal medicine and family practice residents recognizes classic car- diac findings in relevant diseases. Performance does not predictably improve with experience.1 Residency work hours and health care system efficiency standards have severely restricted the time devoted to the mentored cardiovascular examination. In 2020, the SARS-CoV-2 virus pandemic drastically limited in-person interactions, catalyzed a movement to virtual visits (VV) and challenged clinicians to develop alternative means for patient assessment through real-time video obser- vations. It is anticipated that VV will become an established feature of ambulatory patient follow-up. Less attention to bedside skills and declining confidence in the powers of observation have led to increas- ing use of noninvasive imaging, including the use of handheld ultra- sound. Educational efforts, which utilize repetition, patient-centered teaching conferences, simulation, and visual display feedback of aus- cultatory and Doppler echocardiographic findings, can improve physi- cal examination performance