Reclaiming the Cardiovascular Physical Examination in the AI Era: Why Bedside Context Still Truly Matters

Alireza Arzhangzadeh

Department of Cardiology, Shiraz University of Medical Sciences

*Corresponding Author Alireza Arzhangzadeh, Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran, Telephone: +98- 9397603632, Email: Alirezaarjang@gmail.com

Abstract

Background: Artificial intelligence (AI)–enabled decision-support tools are increasingly embedded in cardiovascular care, improving access to guidelines, diagnostics, and risk stratification. However, growing reliance on algorithm-supported workflows may unintentionally de-emphasize bedside clinical skills, particularly the cardiovascular physical examination, at a time when patient context remains central to safe and effective decision making.

Main text: This narrative Perspective reviews historical foundations and contemporary evidence supporting the diagnostic, prognostic, and outcome-related value of cardiovascular physical examination, with particular focus on heart failure and valvular heart disease. We discuss how bedside findings influence risk stratification, therapeutic decisions, and timing of intervention, and examine the limitations of AI-driven tools in capturing social, environmental, and hemodynamic context. We propose an “augmented bedside” model in which AI functions as clinical decision support, while physicians retain responsibility as context-aware managers integrating physical examination, patient goals, and real-world constraints.

Conclusions: In the AI era, cardiovascular care should not move away from the bedside but return to it with enhanced tools. Re-centering practice on a clinically responsible, context-aware physical examination-augmented rather than replaced by AI-offers a practical pathway to improve diagnostic precision and patient outcomes.