Modern cardiac investigations provide important diagnostic and prognostic information, but they have not made physical examination redundant. Although time restraints on consultations may make it difficult to examine patients in primary care, physical examination remains an essential and diagnostically useful part of the consultation. The finding of hypertension, an irregular pulse, signs of heart failure, heart murmurs, a dilated pulsating abdominal aorta, leg swelling, absent leg pulses and femoral artery or carotid artery bruits provides important diagnostic information. Several cardiac conditions can be diagnosed in primary care after a systematic physical examination and attention to discriminatory signs. Patients without cardiac disease are grateful and reassured when told after the examination that they have nothing to worry about. Some physical signs have a low predictive accuracy for diagnosis because they are not specific or sensitive for cardiac disease. Non-specialists may find auscultation difficult and intimidating, but practice with a cardiologist will improve this important and productive clinical skill.